ABSTRACT
As one of the main forms of the medical alliance, the specialty alliance functions as a service carrier for hierarchical medical service and resources integration in the region. The authors introduced the exploration and practice of the West China Women′s and Children′s Alliance, the first pediatric specialty alliance in Sichuan, established by the West China Second Hospital of Sichuan University. Based on family doctor contracted services, the West China Women′s and Children′s Alliance took such measures as differentiated functional positioning, assessment of certified physicians, continuous online quality control, construction of referral platforms, and innovative payment mechanisms. Such efforts effectively integrated the three stages of pre-hospital " preventive care" , in-hospital " disease diagnosis and treatment" , and post-hospital " follow-up management" , exploring the homogenization of medical services within the alliance, and forming a pediatric closed-loop health management system, hence improving the primary medical services.
ABSTRACT
A method was proposed to detect pulmonary nodules in low-dose computed tomography (CT) images by two-dimensional convolutional neural network under the condition of fine image preprocessing. Firstly, CT image preprocessing was carried out by image clipping, normalization and other algorithms. Then the positive samples were expanded to balance the number of positive and negative samples in convolutional neural network. Finally, the model with the best performance was obtained by training two-dimensional convolutional neural network and constantly optimizing network parameters. The model was evaluated in Lung Nodule Analysis 2016(LUNA16) dataset by means of five-fold cross validation, and each group's average model experiment results were obtained with the final accuracy of 92.3%, sensitivity of 92.1% and specificity of 92.6%.Compared with other existing automatic detection and classification methods for pulmonary nodules, all indexes were improved. Subsequently, the model perturbation experiment was carried out on this basis. The experimental results showed that the model is stable and has certain anti-interference ability, which could effectively identify pulmonary nodules and provide auxiliary diagnostic advice for early screening of lung cancer.
Subject(s)
Humans , Algorithms , Lung Neoplasms , Multiple Pulmonary Nodules , Neural Networks, Computer , Radiographic Image Interpretation, Computer-Assisted , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE@#This study was performed to evaluate the accuracy and reliability of a newly designed method to achieve mandibular dental model superimposition, using voxel-based cone-beam computed tomography (CBCT) registration.@*METHODS@#Fourteen dry cadaveric mandibles and six teeth extracted from patients with severe periodontitis were used to establish 14 orthodontic tooth-movement models. The protocol consisted of two steps: in the first step, voxel-based CBCT mandible superimposition was performed; the reference comprised the external portion of the symphysis, extending to the first molar. The laser-scanned dental model image was then integrated with the CBCT image to achieve mandibular dental model superimposition. The entire process required approximately 10 minutes. Six landmarks were assigned to the teeth to measure tooth displacement, using tooth displacement on the superimposed laser-scanned mandibles as the reference standard. Accuracy was evaluated by comparing differences in tooth displacement based on the method and the reference standard. Two observers performed superimposition to evaluate reliability.@*RESULTS@#For three-dimensional tooth displacements, the differences between the method and the reference standard were not significant in the molar, premolar, or incisor groups (p > 0.05). The intraclass correlation coefficients for the inter- and intra-observer reliabilities of all measurements were > 0.92.@*CONCLUSIONS@#Our method of mandibular dental model superimposition based on voxel registration is accurate, reliable, and can be performed within a reasonable period of time in vitro, demonstrating a potential for use in orthodontic patients.
ABSTRACT
Objective To analyze the clinical features and definitive repair strategies of bile duct strictures after hepatectomy.Methods The clinical data of patients undergoing definite repair for bile duct strictures after hepatectomy in the PLA General Hospital from 2000 to 2014 and Beijing Tsinghua Changgung Hospital from 2014 to 2017 were retrospectively collected.Results Twenty-one patients with bile duct stricture after hepatectomy were treated with reoperation.Among them,13 cases showed continuous bile leakage after operation.The types of hepatectomy include 10 cases of left or extended left hemihepatectomy,7 cases of right or extended right hemihepatectomy,2 cases of mesohepatectomy,and 2 cases of hepatic caudate labectomy.According to classification formulated by the Biliary Surgery Group of Chinese Medical Association,the types of injuries of the patients included four of Ⅱ 2,twelve of Ⅱ 3,and five of Ⅱ 4 respectively.19 of 21 patients underwent definitive repair with hepaticojejunostomy.The long-term follow-up success rate was 89.0％.Conclusions Biliary injury after hepatectomy in which the injury affects the secondary or below hepatic ducts requires surgical repair.Hepaticjejunostomy is an effective definitive repair method.Hepaticjejunostomy for bile duct stenosis after right hemihepatectomy always need to dissect the left intrahepatic bile duct by a hilar plate approach or UPV approach,due to the effect of hepatic portal transposition.Surgical repair for bile duct stenosis after the left hepatectomy,always need the incision of the right anterior and right posterior hepatic duct,due to extensive injuries of hepatic duct.
ABSTRACT
The 8th Japan-China Hepato-Pancreato-Biliary Symposium was held in Tokyo,Japan from 22nd to 23rd November 2018.The meeting was convened coincidently with the 80th Annual Congress of Japanese Surgical Association,which attracted the participation of Chinese and Japanese hepatobiliary and pancreatic surgeons.The symposium aimed to explore the latest achievements and clinical issues of diagnosis and treatment for hepato-pancreato-biliary diseases.In this article,authors reviewed the up-to-date research information in order to share the experience,achievements and new information in the field of hepatobiliary and pancreatic diseases with colleagues.
ABSTRACT
Objective To explore clinical efficacy of new types of operation based on perihilar resection to cure hilar cholangiocarcinoma.Methods The retrospective descriptive study was conducted.The clinicopathological data of 4 patients with different Bismuth type of hilar cholangiocarcinoma who were admitted to the Beijing Tsinghua Chunggung Hospital from December 2014 to June 2016 were collected.After preoperative examinations and evaluations,single perihilar resection or combined with central liver segmentectomy were performed.Observation indicators included:(1) intraoperative situations;(2) postoperative pathological examinations;(3) postoperative situations;(4) follow-up.Patients were followed up using outpatient examination up to June 2017.Follow-up included abdominal pain,fever,routine blood test,tumor marker test and imaging examination which detected tumor recurrence and metastasis.Measurement data were represented as average (range).Results (1) Intraoperative situations:4 patients received successful operations,with an average operation time of 512 minutes (range,300-620 minutes).Portal vein was blocked continuously,with an average occlusion time of 70 minutes (range,57-80 minutes),an average volume of intraoperative blood loss was 537 mL (range,200-1 000 mL).Two patients received transfusion of 2 U plasma,4 U plasma + 4 U red blood cell (RBC),respectively.(2) Postoperative pathological examinations:results of postoperative pathological examinations in 4 patients showed that tumor size was respectively 1.5 cm× 1.2 cm× 1.1 cm,1.3 cm× 1.1 cm× 1.0 cm,2.0 cm× 1.7 cm× 1.5 cm and 2.0 cm×2.0 cm× 1.5 cm.Tumor differentiation:1 and 3 patients were respectively detected in moderate-differentiated cholangiocarcinoma and low-differentiated cholangiocarcinoma.Positive nerve plexus invasion was found in all 4 patients and 3 patients had regional lymph node metastasis.Four patients received R0 resection.TNM staging:T2aN1M0 and T2bN1M0 were found in 1 and 3 patients,respectively.(3) Postoperative situations:of 4 patients,1 complicated with biliary leakage was cured by conservative treatment and then discharged from hospital at 67 days;3 had good recovery and then discharged from hospital at day 21,14 and 14,respectively.Patients didn't receive postoperative adjuvant treatment,such as chemoradiotherapy.(4) Follow-up:4 patients were followed up for 12-31 months.During follow-up,4 patients were in good condition,and 1 with transient fever was relieved by conservative treatment.Levels of tumor marker in 4 patients were normal,results of enhanced CT scan showed no signs of tumor recurrence and intrahepatic bile duct dilatation.Conclusion After precisely evaluating the tumor extension among segmental bile duct,single perihilar resection or combined with central segmentectomy can effectively cure hilar cholangiocarcinoma.
ABSTRACT
Objective To explore clinical efficacy of new types of operation based on perihilar resection to cure hilar cholangiocarcinoma.Methods The retrospective descriptive study was conducted.The clinicopathological data of 4 patients with different Bismuth type of hilar cholangiocarcinoma who were admitted to the Beijing Tsinghua Chunggung Hospital from December 2014 to June 2016 were collected.After preoperative examinations and evaluations,single perihilar resection or combined with central liver segmentectomy were performed.Observation indicators included:(1) intraoperative situations;(2) postoperative pathological examinations;(3) postoperative situations;(4) follow-up.Patients were followed up using outpatient examination up to June 2017.Follow-up included abdominal pain,fever,routine blood test,tumor marker test and imaging examination which detected tumor recurrence and metastasis.Measurement data were represented as average (range).Results (1) Intraoperative situations:4 patients received successful operations,with an average operation time of 512 minutes (range,300-620 minutes).Portal vein was blocked continuously,with an average occlusion time of 70 minutes (range,57-80 minutes),an average volume of intraoperative blood loss was 537 mL (range,200-1 000 mL).Two patients received transfusion of 2 U plasma,4 U plasma + 4 U red blood cell (RBC),respectively.(2) Postoperative pathological examinations:results of postoperative pathological examinations in 4 patients showed that tumor size was respectively 1.5 cm× 1.2 cm× 1.1 cm,1.3 cm× 1.1 cm× 1.0 cm,2.0 cm× 1.7 cm× 1.5 cm and 2.0 cm×2.0 cm× 1.5 cm.Tumor differentiation:1 and 3 patients were respectively detected in moderate-differentiated cholangiocarcinoma and low-differentiated cholangiocarcinoma.Positive nerve plexus invasion was found in all 4 patients and 3 patients had regional lymph node metastasis.Four patients received R0 resection.TNM staging:T2aN1M0 and T2bN1M0 were found in 1 and 3 patients,respectively.(3) Postoperative situations:of 4 patients,1 complicated with biliary leakage was cured by conservative treatment and then discharged from hospital at 67 days;3 had good recovery and then discharged from hospital at day 21,14 and 14,respectively.Patients didn't receive postoperative adjuvant treatment,such as chemoradiotherapy.(4) Follow-up:4 patients were followed up for 12-31 months.During follow-up,4 patients were in good condition,and 1 with transient fever was relieved by conservative treatment.Levels of tumor marker in 4 patients were normal,results of enhanced CT scan showed no signs of tumor recurrence and intrahepatic bile duct dilatation.Conclusion After precisely evaluating the tumor extension among segmental bile duct,single perihilar resection or combined with central segmentectomy can effectively cure hilar cholangiocarcinoma.
ABSTRACT
The content of optical isomerism is the difficult point of organic chemistry teaching, and so case-based learning (CBL), theoretical-experimental integration teaching method and micro class teaching methods are tried to be used in classroom teaching according to the actual teaching situations. For CBL teaching method, the course is guided by the step of introduction-question-discussion and summary-exten-sions; For theoretical-experimental integration teaching method, combined with the theory class, the two experiments including the determination of optical rotation and organic molecular model are set for the opti-cal isomer content, to enhance the students' understanding of theoretical knowledge through the hands-on operation;For micro class teaching method, the key and difficult points of this chapter are dug out and about 10 minutes of video are recorded by using common video software before class, which are introduced in the classroom or provided to students after class for repeated watching, to deepen the students' understanding of the concept and phenomenon of optical isomers. In brief, it is important to combine various teaching method to improve the classroom instructing effectively and stimulate the students' interest in organic chemistry.
ABSTRACT
@#Objective To identify the genotype of Toxoplasma gondii isolated strains from a congenital teras（KS strain）and an HIV⁃Toxoplasma co⁃infected patient in Jiangsu Province. Methods T. gondii DNA of tachyzoites of a isolate from a congenital teras（KS strain）and blood DNA of an HIV⁃Toxoplasma co⁃infected patient in Jiangsu Province were extracted，and 11 loci were identified for the genotype by polymerase chain reaction restriction fragment length polymorphism（PCR⁃RFLP）. Results The complete bands were obtained from the congenital teras（KS strain）and HIV⁃Toxoplasma co⁃infected patient in Jiangsu Province，and identified as T. gondii gene type I. Conclusion T. gondii gene type I may be the dominant genotype strain of T. gondii among the women who have the abnormal pregnant outcomes and HIV⁃Toxoplasma co⁃infected patients in Jiangsu Province.
ABSTRACT
Objective To explore the feasibility of electromagnetic navigation for hepatic ducts exploration by choledochoscope based on a three-dimensional (3D) printing model.Methods The retrospective descriptive study was conducted.The clinical data of 1 patient with obstructive jaundice combined with secondary biliary tract dilation who was admitted to the Beijing Tsinghua Changgung Hospital in April 2016 were collected.Digital imaging and standardized format data of enhanced computed tomography (CT) scan were collected,3D reconstruction of liver and bile duct were done under a 3D printing model,and then a hollow model of bile duct was achieved.Choledochoscope with internal electromagnetic probe was inserted into the printed hepatic ducts.Four points of anatomical markers in left and right hepatic ducts and common hepatic duct were chosen as fiducial markers for calibration and registration.Results After registration,the scope can be tracked in main hepatic segmental bile ducts.The locations of choledochoscope matched precisely the navigation results.Conclusion Electromagnetic navigation may bring accurate tracking effectiveness for choledochoscopic examination.
ABSTRACT
Objective To analyze the epidemiological characteristics of imported malaria in Zhangjiagang City. Methods The epidemiological data were collected and retrospectively analyzed for the distribution,cost,and exit-entry mode and port of imported malaria cases in Zhangjiagang City from 2005 to 2015. Results There were 25 imported malaria cases in Zhangjia-gang City from 2005 to 2015,and among them,there were 16 cases of falciparum malaria(64％),6 cases of vivax malaria (24％),and 3 cases of ovale malaria(12％);there was 1 cases of critically ill(4％),there were 8 cases of serious ill(32％) and 16 cases of mild ill(64％). The time of onset was in accordance with the circular distribution. The peak of the incidence of the imported malaria was one month earlier than that of the domestic infection. The seasonal peak was gentle ,and there was also the occurrence in the non-epidemic season in the city. The imported malaria patients were mainly from Africa ,followed by South-east Asia and Oceania. Conclusion The information technology should be applied to improve the key population coverage on the basis of improving the ability of malaria diagnosis and treatment of medical staff and the multi-sector 's cooperation for the im-ported malaria prevention and control in Zhangjiagang City.
ABSTRACT
Objective To study the protective effect of propofol on lipopolysaccharide (LPS)-induced Ana-1 cell damage.Methods The LPS-induced inflammation damage of Ana-1 cells was es-tablished as a model.Ana-1 cells were divided into control group(group C),LPS group(group L), LPS+propofol 10μmol/L group(group LP1),LPS+propofol 20μmol/L group(group LP2),LPS+propofol 40 μmol/L group(group LP3),and LPS+propofol 80 μmol/L group(group LP4),respec-tively.Cell survival rate was assessed using MTT,interleukin 1βand 6,and tumor necrosis factors (TNF-α)were determined.Results Survival rate of Ana-1 cells in group L was lower than that in group C,while it was significantly improved in group LP1,LP2,LP3,LP4 in a dose-dependent man-ner (P <0.01);IL-1β,IL-6,TNF-αrelease was significantly higher in group L than in group C;IL-1β,IL-6,TNF-αrelease significantly reduced in group LP1,LP2,LP3,LP4 (P <0.01)in a dose-dependent manner (P <0.01).Within the selected dose range in this experiment,group LP4 had the best protection effect.Conclusion Propofol can reduce inflammation damage of Ana-1 cells caused by LPS.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the effects of maxillary protraction combined with repetitive rapid palatal expansions and constrictions (RPE/C) vs. rapid palatal expansion (RPE) alone using cone-beam computed tomography (CBCT).</p><p><b>METHODS</b>Twenty four subjects with maxillary retrusion were recruited and block randomized into either the control group (n = 12) or the RPE/C (n = 12) group.</p><p><b>CONTROL GROUP</b>facemask protraction after RPE. RPE/C group: facemask protraction after RPE/C. 3D reconstruction, landmarks identifying, superimposition and cephalometric analysis were performed to compare the pre-treatment and post- treatment CBCT images.</p><p><b>RESULTS</b>One subject in the RPE/C group was lost to follow up during the treatment. Maxilla moved forward [(2.5±1.0) mm] after maxillary protraction with RPE/C, which was significantly greater than that in the control group [(1.6±0.8) mm] (P < 0.05). The distance of basion to subspinale (Ba-A) increased [(3.1±1.0) mm] in the RPE/C group, which was significantly greater than that in the control group [(2.2 ± 0.9) mm] (P < 0.05). The amount of forward movement of upper first molars was significantly greater in the RPE/C group (P < 0.05).</p><p><b>CONCLUSIONS</b>Maxillary protraction with RPE/C might positively affect the forward movement of maxilla compared with the RPE alone protocol with the early treatment of maxillary retrusion patients.</p>
Subject(s)
Humans , Cephalometry , Cone-Beam Computed Tomography , Constriction , Extraoral Traction Appliances , Malocclusion, Angle Class III , Therapeutics , Maxilla , Molar , Palatal Expansion TechniqueABSTRACT
Wnt signaling pathway is not only closely related to tumor invasion and metastasis,such as cancer cells migration and adhesion,extracellular matrix degradation,and angiogenesis,but also plays an important role in self-renewal,proliferation and differentiation of tumor stem cells.Progress has been made in high specific genes drug development and targeted therapy against the Wnt signaling pathway.
ABSTRACT
ObjectiveTo evaluate a computer-assisted operation planning system in curative hepatectomy for complex hilar cholangiocarcinoma.MethodsThe clinical data of 15 patients with complex hilar cholangiocarcinoma who were admitted to the Chinese PLA General Hospital from January 2008 to December 2009 were retrospectively analyzed.Based on triple-phase contrast-enhanced computed tomography inages,a computer-assisted operative planning system was used to evaluate the anatomic relationship between the tumor and its adjacent vessels,liver volume,operative feasibility,and the potential surgical approaches.The accuracy of three-dimensional reconstruction was tested by comparison to actual intraoperative findings.The correlation between actual liver resection volumes and predicted liver resection volumes was analyzed by calculating a Pearson correlation coefficient.Differences in liver volumes calculated by two-dimensional techniques versus three-dimensional reconstruction were analyzed using the paired t test,and the error rate was compared using the chi-squarc test. Results Fifteen patients received curative hepatectomy,including extended hemihepatectomy in 8 patients and trisectionectony in 7 patients.Preoperative evaluation of the hepatic anatomy based on three-dimensional reconstruction imaging was confirmed with operative findings.The sensitivity,specificity and accuracy rates were 100.0％,72.7％ and 72.7％ for patients with portal invasion and 100.0％,78.6％ and 78.6％ for patients with hepatic arterial invasion,respectively.The actual liver resection volume was positively correlated with the predicted liver resection volume ( r =0.974,P ＜ 0.05 ).The mean liver volumes calculated by the three-dimensional reconstruction and the two-dimen-sional techniques were (458 ±86)ml and (491 ± 103 )ml,respectively,with no significant difference (t =-1.911,P ＞0.05 ).The error rates of the three-dimensional reconstruction and the two-dimensional techniques were 4.7％ and 7.2％,respectively,with no significant differnece ( x2 =2.381,P ＞ 0.05 ).Five patients had postoperative complications,and each was cured with conservative or interventional management. Conclusion The application of a computer-assisted operation planning system may improve the safety and accuracy of curative resection for complex hilar cholangiocarcinoma.
ABSTRACT
Objective To observe the survival and reproduction of Oncomelania hupensis snails and their susceptibility to schistosome in schistosomiasis non-endemic area of the Yangtze River estuary in Southern Jiangsu.Methods The soil and water from the Yangtze River estuary of Southern Jiangsu were used for the experiment.The snails reproduced in the same year were collected from the upper reaches of the Yangtze River and raised in the laboratory.The snail survival and reproduction rates and schistosome infection of the snails were observed.The soil collected from schistosomiasis endemic area was used in the control group.Results There was no significant difference between the experimental and control groups for the snail survival rates both in 6 and 12 months (X~2= 0.727 8,P > 0.05 and X~2 = 0.416 1,P > 0.05).Each female snail reproduced 67.69 eggs in average (95 % CI:24.026 0-110.097 4).The average hatchability rate of snail eggs was 83.60%,and there was no significant difference between the 2 groups (X~2= 9.131 8,P > 0.05).The schistosome infection rate of the second generation snails was 1.40% (5/356) 60 days after the infection in the laboratory.Conclusions The snails collected from the upper reaches of the Yangtze River marshland can survival and reproduce in the soil and water from schistosomiasis non-endemic area of the Yangtze River estuary of Southern Jiangsu,and the second generation of the snails can be infected with schistosome in the laboratory.
ABSTRACT
Objective To explore the feasibility of fluorescence quantitative PCR(FQ-PCR)in prenatal diagnosis of the fetal RhD genotyping using free DNA from RhD-negative pregnant women.Methods The fetal RhD gene was amplified from 78 RhD-negative pregnant women with single fetus maternal plasma (gestation from 11 to 40 weeks).Rhe existence of fetal DNA was confirmed by amplification ofnine different polymorphic short tandem repeat loci(STR)and sex-determining region Y chromosome(SRY)gene.Exon5,7,10 and intron 4 were amplified by real-time polymerase chain reaction with TaqMan probe.The results of fetal RhD genotyping were evaluated retrospectively by the serologic analysis of infant cord blood.Results Among the 78 specimens,the SRY positive signals were detected from samples of 41 and were all identified male fetal through 8ex observation after newborn infants delivered from the women enrolled.The mean concentration of SRY gene reached(214.7±120.9)eopies/ml.RhD genotyping results of 70 cases were in complete concordance with the resets through serological detection of fetal cord blood after delivery.In addition,5 cases were false-positive.3 cages were considered inconclusive.The coincidence rate was 90%(70/78).From 5 false-positive cases,4 cases were identified as RhDel phenotype by detecting RHDl227A allele gene.The final accuracy rate of FQ-PCR was 95%(74/78)in the fetal RhD genotyping.Conclusion FQ-PCR analysis for noninvasive prenatal of fetal RhD genotyping could be useful in prevention and diagnosis of hemolytic disease of newborn.
ABSTRACT
Objective To observe the effects of 3,4,5-trihydroxybenzoic acid dimmer (TAD) in different doses on apoptosis and cell cycle progression of liver cancer SMMC-7721 cells in vitro and explore its possible mechanism of inhibiting tumor growth.Methods The experiment was divided into 0,3.125,6.250,12.500 and 25.000 ?g TAD groups. Apoptosis was observed with JEM-1200EX transmission electron microscope (TEM).The changes of apoptosis and cell cycle progression were measured with flow cytometry.Results The typical features of apoptosis were found in tumor cells,the nuclei were broken to pieces,mitochondrion cristae were disrupted and vacuoles were showed in nucleus and cytoplasm in 25.000 ?g TAD group observed under TEM.Meantime,the apoptotic percentages of the cells treated with 3.125—25.000 ?g TAD were increased significantly as compared with control group (P
ABSTRACT
Objective To study the synthesis of lactosaminated carboxymethylchitosan (Lac-CMCS) and its action of delivering plasmid DNA into cells. Methods The lactosaminated carboxymethylchitosan was synthesized by reductive amination and was conjugated with plasmid contained antisense x gene. This complex was delivered into cells and these cells were cultured in 37℃,5%CO_(2). Testing the inhibition on HBV by determining HBsAg and HBeAg produced by HepG2.2.15 cells with ELISA technique. Results The molar ratio between lactose and CMCS was 15∶1 in this covalence conjugate. The best mass ratio of DNA to Lac-CMCS was 1∶10 in DNA/Lac-CMCS which was able to deliver gene into cells, and the ma-ximal inhibition rate was 83.6%. Conclusion In vitro, the lactosaminated carboxymethylchitosan can effectively deliver DNA into cells.