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Objective@#To explore the feasibility, safety and long-term efficacy of laparoscopic total gastrectomy combined with distal pancreaticosplenectomy for the treatment of T4b gastric cancer.@*Methods@#A retrospective cohort study was performed. Clinical data of consecutive patients with T4b gastric cancer invading pancreatic tail undergoing laparoscopic or open total gastrectomy combined with distal pancreaticosplenectomy from January 2010 to December 2014 were analyzed retrospectively. Enrollment criteria: (1) primary gastric cancer confirmed by pathology as T4b adenocarcinoma; (2) chest+abdominal+pelvic enhanced CT indicated cancer invading pancreatic tail without distant metastasis, and R0 resection was evaluated as feasible before operation; (3) physical status was ECOG score 0 to 2, and was tolerant to operation. Patients with peritoneal implant metastasis and tumor invasion of other organs during operation, or changes in surgical methods for other reasons were excluded. All the operations were performed by the same surgical team, which had the experiences of more than 100 cases of laparoscopic and 100 cases of open radical gastrectomy with D2 lymph node dissection. The choice of surgical procedure was discussed by the surgeon and the patient, and decided according to the patient′s intension. Patients were divided into the laparoscopic group and open group according to the surgical method. Intraoperative and perioperative findings were compared between the two groups. The 3-year disease-free survival rate were analyzed with Kaplan-Meier survival curve and compared by using log-rank test.@*Results@#A total of 37 consecutive patients were enrolled, including 21 in the laparoscopic group and 16 in the open group, and no one receiving laparoscopic procedure was converted to open surgery. The baseline data of two groups were comparable (all P>0.05). Compared with the open group, the laparoscopic group had significantly longer operation time [(264.0±35.1) minutes vs. (226.6±49.9) minutes, t=2.685, P=0.011], significantly less intraoperative blood loss [(65.7±37.4) ml vs. (182.2±94.6) ml, t=-4.658, P<0.001], significantly shorter time to postoperative flatus [(2.8±0.7) days vs. (4.1±0.7) days, t=-5.776, P<0.001] and significantly shorter postoperative hospital stay [(13.3±2.8) days vs. (16.6±4.3) days, t=-2.822, P=0.008]. Morbidity of postoperative complications, including anastomotic leakage, pancreatic fistula, abdominal abscess, intraperitoneal hemorrhage and duodenal stump leakage, in two groups was similar [19.0% (4/21) vs. 4/16, P=0.705]. There were no cases of anastomotic bleeding or stenosis. The 30-day postoperative mortality was 0 in the laparoscopic group and 1/16 in the open group, respectively (P=0.432). The 3-year disease-free survival rates were 38.1% and 37.5% in the laparoscopic and open group, respectively (P=0.751).@*Conclusion@#Laparoscopic total gastrectomy combined with distal pancreaticosplenectomy performed by experienced surgeons for T4b gastric cancer is safe and effective.
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Objective@#To investigate the current status of brucella infection in major occupational groups in Bayannur, China, and to analyze the risk factors for brucellosis.@*Methods@#From January to March, 2015, a questionnaire survey and the serological testing were performed to investigate the current status of brucella infection in 649 workers in 13 slaughter and breeding plants in 7 counties in Bayannur, China. The items in the questionnaire survey included general information, related occupational information, living habits, medical history, and awareness of related knowledge.@*Results@#A total of 112 workers (17.26%) had brucella infection. Brucella infection was associated with sex, age, years of exposure to hazardous substances, job, educational background, usage of protective equipment, the presence or absence of a wound at the exposure site, and whether to smoke during the work clearance (P<0.05) . The multivariate analysis showed that the risk factors for brucellosis were meat processing work (OR=1.812) , >5 years of exposure to hazardous substances (OR=1.363) , improper use or nonuse of protective equipment (OR=1.957) , smoke during work (OR=2.027) , and the presence of a woundat the exposure site (OR= 1.231) ; the protective factors for brucellosis were high school and college education and above (OR=0.521) and high rate of awareness of brucella-related knowledge (OR=0.648) .@*Conclusion@#The brucella infection rate is high in the major occupational groups in Bayannur, China. The main influencing factors for brucellosis are job, years of exposure to hazardous substances, usage of protective equipment, whether to smoke during work, and the presence or absence of a wound at the exposure site.
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Objective: To observe the therapeutic effect of video-assisted thoracoscopic surgery (VATS) with iodine tincture pleurodesis on malignant pleural effusion (MPE). Methods:Clinical data from 47 MPE cases were retrospectively analyzed. Based on different treatments, the 47 cases were divided into Groups A (n. 25) and B (n. 22), which used iodine tincture and talc powder as a hard-ener, respectively. Provided that all cases were conclusively diagnosed as MPE, and the patients underwent VATS pleural biopsy and pleurodesis, Groups A and B were comparable. The authors then compared the postoperative effectiveness rates (both complete and par-tial remissions), the volume of chest drainage, the incidence of adverse reactions, and the drainage time of the chest tube between the two groups. Results:Difficulty in breathing was proven to be less severe among all cases after the operation, and none of the patients suffered from acute lung injuries. After the operation, Group A exhibited an effectiveness rate of 96.0%, whereas Group B presented a rate of 95.5%, which indicates that no significant difference was found between the two groups (P>0.05). The total incidence of adverse reactions was 32.0%in Group A and 63.6%in Group B, with a significant difference between the two (P<0.05). Conclusion:VATS io-dine tincture pleurodesis has been proven to be as therapeutically effectual as talc pleurodesis and has resulted in fewer adverse reac-tions. This finding suggests that VATS iodine tincture pleurodesis has a promising potential in clinical practice because of its definite cu-rative effect, simple management, high security, fewer adverse reactions, and reasonable cost.
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Objective:To evaluate the clinical value of percutaneous microwave coagulation therapy for peripheral non-small-cell lung cancer. Methods:We evaluated 35 patients with non-small-cell lung cancer who received percutaneous microwave coagulation therapy and 35 patients who received radiotherapy from March 2004 to September 2006;the patients were sex-matched, age-matched, and had the same pathology and clinical staging. Clinical effects were observed and assessed. Survival rate were calculated using the Kaplan-Meier method. The difference in survival rate between the two treatment methods was analyzed using a log-rank test. Results:The 1-year, 3-year, and 5-year survival rates for the microwave coagulation therapy group (71.4%, 40.0%, and 20.0%, respectively) were significantly higher than those for the radiation therapy (51.4%, 22.9%, and 11.4%, respectively) (P<0.05). Conclusion:Percutaneous microwave coagulation therapy is a minimally invasive, safe, and effective alternative for patients with peripheral non-small-cell lung cancer who cannot undergo routine surgery because of poor heart and lung function or fear of surgical trauma.
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Medical education should combine clinical professional skills with humanities skills,integrate humanities knowledge into vocational education.Taking 2008 grade seven-year program clinical medicine students in the 2nd affiliated hospital of Harbin Medical University as fostering object,we made researches into students' understanding of doctor-patient relationship before practice and their mastering of skills.Through conducting questionnaire,we got to know the effect of humanities practice skill training for seven-year program clinical medicine students.Meanwhile,we compared students' self evaluation results before and after training,discussed on how to improve medical students' communication skills,cultural skills and the reform direction in an aim to guide students to transit from students to clinical doctor.
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Objective To investigate the expression of serum soluble cytotoxic T lymphocyte associated antigen 4 (sCTLA4), the association of sCTLA4 level with erythrocyte sedimentation rate (ESR) and C reactive protein (CRP), as well as its role in patients with Crohn's disease (CD). The relationship-1661A/G and -1722T/C polymorphisms of CTLA4 gene and between disease susceptibility and phenotype of CD was analyzed. Methods A total of 126 CD patients and 300 healthy controls were enrolled in the study. Serum sCTLA4 level was determined by enzyme-linked immunosorbent assay. The concentrations of ESR and CRP were analyzed by automatic ESR Analyzer SRS 100/Ⅱ and rate nephelometry, respectively. The polymorphisms of CTLA4-1661A/G and -1722 T/C were genotyped by DNA sequencing. Results Serum sCTLA4 level was higher in CD patients than in healthy controls [(18. 70±3. 72) ng/ml vs (1.72±0. 32) ng/ml, P＜0. 01)]. Among CD patients, sCTLA4 level was higher in patients with active disease when compared to those with inactive disease [(19.83±4.35) ng/ml vs (18. 02±3.14) ng/ml, P=0. 015)]. sCTLA4 level was positively correlated with ESR and CRP levels (r=0. 267, P=0. 003; r=0. 524 P ＜0.01, respectively). In CD patients, serum sCTLA4 level was significantly higher in those with stricturing disease behavior than that in those without stricturing and penetrating or with penetrating disease behavior (P= 0.021; P=0. 015, respectively). Detection of CTLA4 -1661A/G and -1722T/C polymorphisms showed no significant difference between CD patients and healthy controls. Conclusions The high level of serum sCTLA4 in CD patients is correlated with disease activity, CRP levels and disease behavior. It suggests that sCTLA4 may play an important role in pathogenesis of CD.
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Objective To investigate the function of major histocompatibility complex (MHC)class Ⅰ-related gene (MIC) in ulcerative colitis (UC) pathogenesis. Methods The difference of MICA, M ICB and their ligand NKG2D genes expression in colonic mucosa tissue of 34 UC patients and 12 healthy people were determined by fluorescent real-time reverse-transcriptase polymerase chain reaction (RT-PCR) and the expression location of M ICA in colonic mucosa tissue was obtained by laser scanning confocal microscope. Results The mRNA level of MICA, MICB and NKG2D expression in UC groups (3. 5408±2. 6658, 8. 9879±3. 2893 and 2. 4395±0. 8147 accordingly) was significantly higher than that in the healthy controls ( 1. 0477 ± 0. 7201, 4. 6293 ± 1. 2616 and 1. 1624±0. 3954 accordingly) (P = 0.0053, 0.0039 and 0. 0078 accordingly). It suggested that MICA was expressed in colonic epithelia cell membranes by laser scanning confocal microscopy.Conclusion The mRNA level of MICA, M ICB, and their ligand, NKG2D expression were all up regulated in the colonic mucosa of UC patients, which indicated MIC gene might perform important local function in UC.
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Objective: To observe the expression of hMLH1 protein in esophagus squamous cell carcinoma, atypical hyperplasia tissue and normal esophagus tissue, so as to discuss the relationship between hMLH1 expression and esophagus carcinogenesis. Methods: The specimens of esophagus squamous cell carcinoma, atypical hyperplasia and normal esophagus tissue were obtained from 92 esophagus carcinoma patients. Immunohistochemistry (IHC) staining technique was used to detect expression of hMLH1 protein. The relationship between hMLH1 expression with clinical parameters, such as gender, age, cancer differentiation level, infiltration depth, tumor stage, lymphatic metastasis, was analyzed. Results: The positive rates of hMLH1 protein in esophagus squamous cell carcinoma, and atypical hyperplasia tissue and normal esophagus tissue were 36.96%,56.52%, and 84.78%,respectively,with the former 2 significantly lower than the latter (P