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The revised revision of the Shenzhen Special Economic Zone Medical Regulations passed in 2022 is an important institutional innovation in China, while many problems still need to be solved in the specific practice and application. This paper compared the practical development characteristics of the living will system between China and Japan, and analyzed the relationship between doctor-patients relationship under the intervention of the living will system and the symbolic representation mechanism of living will by using the semiotics theory. According to the links of "addresser-symbolic text" and "symbolic text-addressee", the six types of problems faced by current living will system in China were discussed, and the relevant experience and enlightenment were summarized to provided reference for the development of the living will system in China.
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Objective:To explore the protective effect of nerve plane-oriented laparoscopic total mesorectal excision (NPO+ LTME) for postoperative urinary and sexual function in patients with rectal cancer.Methods:Retrospective analysis was performed on rectal cancer patients who received surgical treatment at Renmin Hospital of Wuhan University from Jan 2016 to Dec 2018, including 114 patients in the NPO+ LTME group and 92 patients in the laparoscopic TME combined with pelvic autonomic nerve preservation (LTME+ PANP) group. Surgical and tumor-related indicators were recorded and compared between the two groups, and postoperative urination and sexual function were followed up.Results:There was no significant difference in baseline indicators between the two groups ( P>0.05). The operative time of the two groups was (150±7) min and (154±7) min, respectively ( t=3.585, P<0.05). Intraoperative bleeding was (9±3) ml and (15±6) ml ( t=7.654, P<0.05), respectively.Three months after surgery, the rate of urinary dysfunction in the NPO+ LTME group was lower than that in the LTME+ PANP group ( Z=2.549, P<0.05), but there was no difference between the two groups 6 and 12 months after surgery ( Z=0.814, P>0.05 and Z=1.275, P>0.05). At 3, 6 and 12 months after surgery, the erectile function in NPO+ LTME group was better than that in LTME+ PANP group ( Z=4.917, P<0.05; Z=4.947, P<0.05 and Z=4.081, P<0.05); The rate of ejaculation dysfunction was also lower than that of the LTME+ PANP group ( Z=4.464, P<0.05; Z=4.948, P<0.05 and Z=4.434, P<0.05); In addition, postoperative female sexual function was superior to LTME+ PANP group ( Z=2.532, P<0.05; Z=2.364, P<0.05; Z=2.076, P<0.05). Conclusion:NPO+ LTME has good surgical safety and also has certain advantages for patient sexual function and early urinary function protection.
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Objective@#Using previous total mesorectal excision with pelvic autonomic nerve preservation (PANP+TME) and simple total mesorectal excision (TME) without emphasis on retained nerves as control, we explore the advantages of nerve plane-oriented laparoscopic total mesorectal excision (NPO+LTME) on urinary and sexual function.@*Methods@#A retrospective cohort study was carried out. Case inclusion criteria: (1) male patients with pathologically confirmed middle and low rectal adenocarcinoma (4 to 11 cm from the anus); (2) stage T1-2tumor; (3) normal sexual life before operation. Exclusion criteria: (1) no pathological diagnosis before surgery; (2) local recurrence or distant metastasis; (3) preoperative neoadjuvant chemoradiotherapy; (4) opensurgery and laparoscopic surgery conversionto open; (5) no follow-up data. According to the above criteria, clinical data of 173 male patients with low and middle rectal adenocarcinoma who underwent radical operation for laparoscopic rectal cancer from July 2003 to July 2018 at the Department of Gastrointestinal Surgery, Wuhan University People′s Hospital were collected. According to different surgical methods, patients were divided into TME group (58 cases), PANP+TME group (63 cases) and NPO+LTME group (52 cases). There were no significant differences in the baseline data including age, body mass index and pathological examination between the 3 groups (all P>0.05). The nerve plane referred to the nerve, the adipose tissue, the extremely finecapillaries around the nerve with overlying fine membranous tissue. NPO+LTME referred to the process of laparoscopic TME guided by the nerve plane, performing in the loose connective tissue between the nerve plane and the rectal properfascia, in order to ensure the integrity of the nerve plane, and maximally protect the patient's urinary and reproductive functions. The operation time, intraoperative blood loss, urinary catheter removal time, urinary function grading, postoperative first erection time, and erectile function and ejaculation function were observed and compared among the 3 groups at 3- and 6-month after operation.@*Results@#In the NPO+LTME group, the PANP+TME group and the TME group, the operation time was (181.9±24.5) minutes, (176.7±29.2) minutes and (137.7±16.2) minutes, respectively (F=54.868, P<0.001); the intraoperative blood lost was (6.0±1.4) ml, (6.5±1.8) ml and (12.8±4.6) ml, respectively (F=95.016, P<0.001); the time to postoperative removal of the catheter was (2.4±1.1) days, (3.7 ±1.7) days and (6.5±2.4) days, respectively (F=79.409, P<0.001); the first postoperative erection time was (1.6±0.6) days, (8.9±2.7) days and (15.9±6.8) days (F=177.677, P<0.001), respectively, whose differences were all statistically significant (all P<0.01). In comparison of urinary function grading, the proportion of grade I (normal function, no urinary dysfunction) in the NPO+LTME, the ANP+TME group and the TME group was 84.1% (53/63), 39.7% (23/58) and 19.2% (10/52), respectively, and the difference was statistically significant (H=52.915, P<0.001). At postoperative 3- and 6-month, proportion of patients with grade I erectile function (normal erectile function) was 77.8% (49/63) and 85.7% (54/63), 44.8% (26/58) and 53.4% (31/58), 28.8% (15/52) and 48.1% (25/52) in the NPO+LTME group, the PANP+TME group, and the TME group, respectively. The differences were statistically significant (H=91.709, P<0.001; H=79.692, P<0.001). The proportion of patients with grade I ejaculation function (with ejaculation, no abnormalities in routine semen examination before and after surgery) at 3- and 6-month after surgery in the NPO+LTME group, the PANP+TME group and the TME group was 82.5% (52/63) and 87.3% (55/63), 53.4% (31/58) and 60.3% (35/58), 28.8% (15/52) and 46.1% (24/52), respectively. The differences were statistically significant as well (H=86.543, P<0.001; H=78.667, P<0.001). Patients in the NPO+LTME group had no grade III erections and ejaculation disorders.@*Conclusion@#The surgical procedure of NPO+LTME can promote the recovery of postoperative neurological function and preserve urination and sexual function better.
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Objective@#To analyze the relationship between tumor deposits(TD) and clinicopathological features of locally advanced gastric cancer(LAGC) patients.@*Methods@#The clinicopathological characteristics of 300 LAGC patients undergoing radical gastrectomy in Renmin Hospital of Wuhan University from Jan 2014 to Jul 2017 were collected. The relationship between clinicopathological features and prognosis of LAGC patients and TD status in LAGC patients were analyzed retrospectively.@*Results@#TD were positive in 65(21.7%) patients. Univariate analysis showed that the depth of invasion, lymph node metastasis, pTNM stage, tumor size, vascular invasion, preoperative tumor markers were correlated with the status of TD(all P<0.05). Multivariate Logistic regression analysis showed that lymph node metastasis, pTNM stage, vascular invasion and depth of invasion were independent risk factors for positive TD (allP<0.05). Univariate analysis on prognosis of LAGC patients showed lesion location, degree of differentiation, lymph node metastasis, pTNM stage, tumor size, positive TD, number of TD and vascular invasion are associated with prognosis of LAGC (all P<0.05). Multivariate COX regression analysis showed that the number of TD >3 was an independent risk factor for the prognosis of LAGC patients(HR=2.242, 95% CI: 1.484-3.386, P=0.000). The median survival time of TD-positive LAGC was less than TD-negative group(χ2=91.077, P<0.001). The median survival time of TD number>3 group was significantly shorter than that in TD number<3 group and TD-negative group(χ2=192.969, P<0.001).@*Conclusions@#TD are closely related to tumor stage in LAGC patients. The status of TD is an independent risk factor for the prognosis of LAGC. Multiple TDs indicate poor prognosis of LAGC patients.
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Objective To analyze the relationship between tumor deposits (TD) and clinicopathological features of locally advanced gastric cancer (LAGC) patients.Methods The clinicopathological characteristics of 300 LAGC patients undergoing radical gastrectomy in Renmin Hospital of Wuhan University from Jan 2014 to Jul 2017 were collected.The relationship between clinicopathological features and prognosis of LAGC patients and TD status in LAGC patients were analyzed retrospectively.Results TD were positive in 65(21.7％) patients.Univariate analysis showed that the depth of invasion,lymph node metastasis,pTNM stage,tumor size,vascular invasion,preoperative tumor markers were correlated with the status of TD(all P ＜0.05).Multivariate Logistic regression analysis showed that lymph node metastasis,pTNM stage,vascular invasion and depth of invasion were independent risk factors for positive TD (all P ＜ 0.05).Univariate analysis on prognosis of LAGC patients showed lesion location,degree of differentiation,lymph node metastasis,pTNM stage,tumor size,positive TD,number of TD and vascular invasion are associated with prognosis of LAGC (all P ＜ 0.05).Multivariate COX regression analysis showed that the number of TD ＞ 3 was an independent risk factor for the prognosis of LAGC patients (HR =2.242,95％ CI:1.484-3.386,P =0.000).The median survival time of TD-positive LAGG was less than TD-negative group(x2 =91.077,P ＜ 0.001).The median survival time of TD number ＞ 3 group was significantly shorter than that in TD number ＜ 3 group and TD-negative group (x2 =192.969,P ＜0.001).Conclusions TD are closely related to tumor stage in LAGC patients.The status of TD is an independent risk factor for the prognosis of LAGC.Multiple TDs indicate poor prognosis of LAGC patients.
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Objective To evaluate the effect of silencing ACAT1 gene on colon cancer cells proliferation,migration,invasion and colon cancer development by using the small interference RNA (siRNA) in colon cancer cell line HT-29.Methods Acyl coenzyme A cholesterol acyltransferase 1 (ACAT1) gene was silenced in HT-29 cell lines using Hiperfect transfection reagent.The expression level of ACAT1 was detected by real time PCR.CFSE and transwell assays were used to evaluate the effect of ACAT1 gene interfering on cells proliferation,mi gration and invasion.Result ACAT1 mRNA expression decreased obviously after siRNA interference.Compared with pre-transfection,proliferation,migration and invasion of colon cancer cells have been significantly inhibited (P ＜ 0.05).Conclusion ACAT1 gene interference reduced proliferation,migration and of invasion of HT29 cells,which provide a new potential target for colon cancer treatment.
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Objective To research the effect and mechanism of phosphatidylinositol 3‐kinase(PI3K)/serine threonine protein kinase(AKT) and mitogen extracellular signal‐regulated kinase(MEK)/extracellular signal‐regulated kinase(ERK) signaling path‐way in tumor vascular endothelial cell migration .Methods The different concentrations of PI3K/AKT signaling pathway inhibitor LY294002 (2 .50 ,7 .50 ,15 .00 μmol/L) and the MEK/ERK signaling pathway inhibitor PD98059 (2 .50 ,7 .50 ,15 .00 μmol/L) were used to treat the tumor‐derived endothelial cells respectively .The DMEM‐F12 culture medium was added into 0 .10% DMSO culture medium as the control .The cell scratch test ,cell directional migration test and Transwell test were adopted to detect the effects of different signaling pathway inhibitors on the tumor vascular endothelial cells level ,horizontal ,vertical and directional mi‐gration .Results 0 .10% DMSO had no significant effect on endothelial cell migration and the role of endothelial cells′migration a‐bility after its action had no obvious difference compared with the single DMEM‐F12 medium action ,indicating that small doses of DMSO as the solvent of LY294002 ,PD98059 did not affect the tumor vascular endothelial cell migration function ;after treatment by signaling pathway inhibitor LY294002 and PD98059 ,the endothelial cell migration ability was suppressed and increased with the in‐hibitor concentration increase ;compared with the PD98059 group ,the migration distance in the LY294002 group was smaller and the number of migrating cells was less ,the differences had statistical significance (P<0 .05) .Conclusion The inhibition of PI3K/AKT and MEK/ERK signaling pathway can inhibit the level of tumor vascular endothelial cells ,vertical and directional migration , and which is positively correlated with the concentration of inhibitor ;the effect of PI3K/AKT signal pathway on the migration of endothelial cells is more significant than that of the MEK/ERK signal pathway .
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Objective To investigate the causes,diagnosis and treatment of small intestine bleeding.Methods Sixty-eight cases of small intestine bleeding from January 2000 to June 2010 were retrospectively analyzed.Among all cases,4 underwent routine hemostatic treatment under colonoscopy,40treated with open surgery and 24 patients with laparoscopic therapy.Among them,57 cases underwent part resection for some small intestine,completely laparoscopic resection of diverticula was performed in 7patients.Results Neoplasms was the leading cause of small intestine bleeding,accounting for 48.5％ (33/68)in these patients,followed by small intestine diverticulum accounted for 29.4％ ( 20/68 ),intestinal infective diseases accounted for 14.7％ ( 10/68 ) and vascular disease accounted for 7.4％ ( 5/68 ).Conclusion The clinical manifestations of small intestinal bleeding showed no specific signs.Neoplasm,intestine diverticulum and intestinal infective diseases are the most common causes of small intestinal bleeding.Small intestinal bleeding can be diagnosed in intraoperative colonoscopy.Surgery is the most effective treatment for small intestinal bleeding.
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Objective To observe effects of hydroxyethyl starch(130/0.4,voluven)on tissue perfusion and serum TNF-α,IL-6,IL-8 levels in patients with severe acute pancreatitis(SAP).Methods 60 SAP patients with non-operative treatment were randomly divided into voluven group and Ringer's solution group(n =30 per group).In addition to conventional drugs and treatment,of which voluven group daily 15ml/kg intravenously for 5 d;Ringer's solution group daily 20ml/kg intravenously for 5d.Hemodynamic parameters and tissue perfusion indicators were monitored,TN F-α,IL-6,IL-8 levels were examined after treatment 0,12,24,48,96 hours.Results Compared with Ringer solution group,Voluven group therapy high efficiency,faster raise MAP,ScvO2,Phi value,lower HR,Hct(t =2.785,3.126,4.132,3.168,2.218,all P ＜ 0.05).TNFα,IL-6 after 48h treatment,IL-8 after 96h treatment,both groups were significantly decreased,but the voluven group was significantly lower than Ringer's solution group(P ＜ 0.05).Conclusion Voluven could effectively and quickly maintain hemodynamic stability,improve the hemorheological and tissue perfusion,could be more conducive to improving the pancreatic microcirculation,thus inhibiting inflammatory cytokines TNF-α,IL-6,IL-8 release,and had favorable treatment effect on patients with SAP.
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Objective To analyze the blood perfusion characteristics of retroperitoneal benign and malignant tumors by real-time contrast enhanced ultrasonography and discuss its value in the differential diagnosis.Methods The study involved 42 patients with pathological evidence through surgery or needle biopsy,including 12 patients with benign retroperitoneal tumors and 30 patients with malignant retroperitoneal tumors.The blood perfusion characteristics of two groups were observed under low mechanical index after the injection of contrast ultrasound agent(SonoVue),and the changes of twodimensional ultrasonography and the time-intensity curve(TIC)were analyzed. Results During real time contrast enhancement,the different characteristics of retroperitoneal benign and malignant tumors were observed.Malignant tumors in retro peritoneum presented the pattern of ultrasound contrast agent(UCA) enhancement from center to periphery and enhanced overall uneven mainly,begin tumors presented peripheral enhancement pattern or uniformity and overall strengthening of the main.TIC curve between benign and malignant tumors displayed that contrast enhanced intensity of region of interest(P＜0.00 1),ascending slop and halftime of descending were statistically significant(P＜0.05).Conclusions Real-time contrast-enhanced ultrasonography is a valued method to provide information for the differential diagnosis in retroperitoneal benign and malignant tumors.
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Objective To study the application of ultracision harmonic scalpel in laparoscopic radical gastrectomy.Methods Ten patients with gastric cancer were given laparoscopic-assisted radical gastrectomy by using ultracision harmonic scalpel.Results All operations were successfully performed with ultracision harmonic scalpel,and none of which converted into open surgery.The operation time was 300-492 min,mean(385?64) min.The blood loss was 100-500 ml,mean(401?70) ml.The number of harvested lymph nodes was 21-43,mean 31?6.The time for gastrointestinal function recovery was 3-6 d,mean(4.2?1.0) d.The time of patients' taking out-of-bed activity was 3-7 d,mean(4.5?1.3) d.The time of taking liquid food was 4-6 d,mean(5.0?0.9) d.No case had relapse or metastasis after 4-20 months(mean 12.6 months) of follow-up.Conclusions Laparoscopic radical gastrectomy by using ultracision harmonic scalpel is safe and feasible.Ultracision harmonic scalpel has the advantage of minimal invasion,less bleeding and shorter operation time,which is a very important equipment and useful for laparoscopic gastrointestinal surgery.
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Objective To investigate the correlation between postoperative intraabdominal adhesions and tumor growth and metastasis and to evaluate the effect of PDLLA. Methods Sixty male Wistar rats were divided into tumor transplantation group ( A group) and non-tumor-transplantation group (B group). Both groups were further subdivided into intraabdominal adhesion model subgroup, PDLLA intervention subgroup and false operation subgroup respectively. Postoperative intraabdominal adhesions and tumor growth and metastasis were semiquantitively scored 4 weeks after the operation. Results The scores of intraabdominal adhesion and the tumor growth and metastasis in all subgroups of tumor transplantation group were higher than that of non-tumor-transplantation group ( P