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Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.
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AIM:To elucidate the possible biological mechanism of silica-induced acute lung injury in rats.METHODS:Sixteen Male Sprague-Dawley rats were divided into control and acute silicosis model groups,and instilled intratracheally with 1 mL of normal saline and 50 g/L silica suspension,respectively.After 7 d,the rats were sacrificed for collection of lung tissue and serum.The serum levels of interleukin-1β(IL-1β),IL-18 and tumor necrosis factor-α(TNF-α)were measured by using ELISA.The protein expression levels of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)and gasdermin D(GSDMD)were measured by immunohistochemistry.Bacterial DNA was ex-tracted from the lung tissue for 16S ribosomal RNA gene sequencing to characterize changes in the composition of lung flo-ra.The differences in the structure of bacterial flora between control and model groups were analyzed by bioinformatic analy-ses.RESULTS:Immunohistochemical analysis showed that the protein expression levels of NLRP3 and GSDMD were higher in the lungs of the rats in model group.In addition,serum cytokine profiling showed that IL-1β,IL-18 and TNF-α levels were significantly higher in model group.The most abundant bacterial genera in the lung flora of the rats in model group were Bifidobacterium,Clostridium sensu stricto 1,and Parasutterella.The NLRP3 and GSDMD levels in the lung tissue and IL-1β and TNF-α levels in serum were positively correlated with the abundance of Parasutterella.CONCLU-SION:The alterations in lung flora structure and increased inflammation levels may be the actual biological mechanisms underlying silica-induced acute lung injury.The modulation of lung flora may provide a basis for the prevention and treat-ment of silica-induced acute lung injury.
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Objective:To investigate the effect of adjusting density exposure steps on image quality and radiation dose in digital mammography.Methods:Using the automatic exposure control (AEC) mode of the digital mammography machine, five different gland thicknesses of 4.3, 5.3, 6.3, 7.3, and 8.3 cm were simulated by attaching 0, 1, 2, 3, and 4 PMMA plexiglass plates under the RMI-156 modal body, and the density exposure steps were adjusted to -3, -2, -1, 0, 1, 2, 3, and 4 for each thickness. The target/filter combination, tube voltage, tube current, incident body surface dose (ESD), incident surface air kerma (ESAK), half-value layer (HVL) and the average glandular dose displayed by the device (displayed AGD) were recorded at each step and thickness, and the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), figure of merit (FOM) and the calculated average glandular dose (calculated AGD) were calculated. Then, the display effects of simulated fibers, simulated calcifications and simulated masses within the modal body were scored subjectively, and the changes in image quality and radiation dose at different steps were analyzed, and the relationships between ESD and ESAK, displayed AGD and calculated AGD, and displayed AGD/ESD and calculated AGD/ESAK were analyzed. A linear fit was used for the steps with SNR, CNR, and FOM, and an exponential function curve fit was used for the steps with mAs, ESAK, and calculated AGD. The differences between ESD and ESAK, displayed AGD and calculated AGD, and displayed AGD/ESD and calculated AGD/ESAK were analyzed by paired-samples t test. Results:The CNR and SNR of mammographic images rose and fell by about 8% with each increase or decrease of one step. The scores of image simulated fibers, simulated calcifications, and simulated masses showed an overall upward trend with increasing steps, but there were still cases where the scores decreased with increasing grades. FOM varied from 97% to 104% at each grade with little variability. ESD, ESAK, displayed AGD, and calculated AGD, which could measure radiation dose, showed an exponential trend of increasing function with increasing steps, with a variation of about 63% to 165%. There were statistically significant differences ( t=-9.61, P=0.001) between ESD (15.14±10.08) and ESAK (16.66±11.07). However, there were no statistically significant differences ( t=1.20, P=0.240) between displayed AGD and calculated AGD, which were 3.66±2.18 and 3.61±1.99, respectively. Conclusions:The adjustment of density exposure steps can make the image quality change linearly and the radiation dose change exponentially with increasing speed, and the mode and magnitude of the adjustment are appropriately stable with high application value.
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Objective:To analyze the clinically acceptable and reproducible bladder and rectum volumes of prostate cancer patients during radiotherapy under bladder and bowel preparation, aiming to provide quantitative indicators for bowel and bladder preparation before and after radiotherapy.Methods:Clinical data of 275 prostate cancer patients with strict bladder and bowel preparation and completion of whole course radical radiotherapy at Sun Yat-sen University Cancer Center from April 2015 to December 2020 were retrospectively analyzed. Patients were scanned with cone beam CT (CBCT) before each treatment and the setup error was recorded. Sixty-six patients were selected by simple random sampling and the bladder and rectum on daily CBCT was outlined using MIM software. The relationship between the ratio of daily bladder or rectum volume to the planned bladder or rectum volume (relative value of volume) and setup error was analyzed. Quantitative data were expressed as mean±SD. Normally distributed data were analyzed by paired t-test while non-normally distributed data were assessed by Kruskal-Wallis test.Results:The bladder and rectum volume on planning CT were (370.87±110.04) ml and (59.94±25.07) ml of 275 patients. The bladder and rectum volumes on planning CT were (357.51±107.38) ml and (65.28±35.37) ml respectively of the 66 selected patients with 1611 sets of CBCT images. And the bladder and rectum volumes on daily CBCT were (258.96±120.23) ml and (59.95 ± 30.40) ml. The bladder volume of patients was decreased by 3.59 ml per day on average during the treatment and 0.37 ml for the rectum volume. According to the bladder volume on planning CT, all patients were divided into three groups: <250 ml, 250-450 ml and >450 ml groups. The relative value of volume in the 250-450 ml group during the course of radiotherapy was the smallest. And the setup error in the superior and inferior (SI) direction was (0.28±0.24) cm and (0.19±0.17) cm in the left and right (LR) direction, significantly lower than those in the other two groups (both P≤0.027). According to the rectum volume on planning CT, all patients were divided into four groups: <50 ml, 50-<80 ml, 80-120 ml and >120 ml groups. The <50 ml group had the smallest relative value of volume during radiotherapy, and the setup error in the SI direction was (0.26±0.22) cm and (0.24±0.22) cm in the anterior and posterior (AP) direction, significantly smaller than those in the other groups (both P≤0.003). The setup errors in the SI, LR, AP directions of the enrolled 66 patients were (0.30±0.25) cm, (0.20±0.18) cm and (0.28±0.27) cm, respectively. Among them, the relative value of bladder volume in the AP direction was (0.73±0.37) in the setup error <0.3 cm group, which was statistically different from those in the setup error 0.3-0.5 cm and >0.5 cm groups (both P<0.05). Conclusion:Under the bladder and bowel preparation before planning CT, the appropriate bladder and rectum volumes are in the range of 250-450 ml and <50 ml, which yields higher reproducibility and smaller setup error.
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Aim To investigate the effect of quercetin (Que) on secretory otitis media (SOM) rats and its mechanism. Methods Forty-eight male SD rats were selected and randomly divided into control group (control), model group (model), Que group (100 mg • kg
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Objective:To investigate the application value of Da Vinci robotic transanal minimally invasive surgery (R-TAMIS) for local resection of rectal neoplasms.Methods:The retros-pective and descriptive study was conducted. The clinicopathological data of 7 rectal neoplasms patients undergoing R-TAMIS in Daping Hospital of Army Medical University from June 2017 to March 2021 were collected. There were 3 males and 4 females, aged (60±7)years. Observation indicators: (1) intraoperative situations; (2) postoperative recovery; (3) postoperative histopatholo-gical examinations; (4) follow-up. Follow-up was conducted using telephone interview or outpatient examination to detect readmission of patients within postoperative 30 days, tumor recurrence and metastasis and survival of patients. Follow-up was performed at postoperative 1, 3, 6 months and once every 6 months thereafter up to April 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All the 7 patients underwent R-TAMIS successfully without conversion to laparotomy or laparoscopic surgery. Of the 7 patients, 2 cases underwent full-thickness rectal resection and 5 cases underwent submucosal dissection of tumor. The rectal wounds were not sutured in 2 cases because of large lesions, and the rectal wounds were sutured with synthetic sutures in 5 cases after resection of lesions. Transanal drainage tube was placed in 2 cases and not in 5 cases. The volume of intra-operative blood loss of the 7 patients was 15(range, 2?50)mL. The total operation time of the 7 patients was (91.4±18.4)minutes, including (19.1±2.3)minutes for transanal platform placement and Da Vinci robotic surgical system installation, and (72.3±16.6)minutes for operation. There was no intraoperative complication such as urethral injury. (2) Postoperative recovery. All the 7 patients started water drinking and out-of-bed activities at postoperative day 1 and liquid food intake at postoperative day 2. The time to postoperative first flatus of the 7 patients was 1(range, 1?3)days. The two cases with transanal drainage underwent removing of transanal drainage at postoperative day 2. There was no postoperative complication and the duration of postoperative hospital stay of the 7 patients was 3(range, 3?9)days. (3) Postoperative histopathological examinations. Of the 7 patients, 3 cases had villous adenoma, 2 cases had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor invasion into submucosa (stage SM1), 1 case had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor localized in the inner mucosa (stage Tis) and 1 case had moderately differentiated adeno-carcinoma with tumor invasion into superficial muscle layer (stage T2). All the 7 patients had negative surgical margins with none of tumor cell remained in the base. (4) Follow-up. All the 7 patients were followed up for 18(range, 1?42)months. One of the 7 patients showed rectal adenocarcinoma with tumor invasion into superficial muscle layer by the postoperative histopathological examina-tion and was recommended for remedial radical surgery. The patient refused further surgery and underwent 3 courses of oral capecitabine chemotherapy. The other 6 patients did not receive postoperative chemotherapy. None of 7 patients underwent readmission within postoperative 30 days, and no patient had tumor local recurrence, distant metastasis or death during the follow-up.Conclusion:R-TAMIS for local resection of rectal neoplasms is safe and feasible for patients with rectal adenoma and early rectal cancer, with reliable short-term efficacy and short-term oncological efficacy.
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OBJECTIVE@#Traditional epidemiological studies have shown that C-reactive protein (CRP) is associated with the risk of cardiovascular diseases (CVDs). However, whether this association is causal remains unclear. Therefore, Mendelian randomization (MR) was used to explore the causal relationship of CRP with cardiovascular outcomes including ischemic stroke, atrial fibrillation, arrhythmia and congestive heart failure.@*METHODS@#We performed two-sample MR by using summary-level data obtained from Japanese Encyclopedia of Genetic association by Riken (JENGER), and we selected four single-nucleotide polymorphisms associated with CRP level as instrumental variables. MR estimates were calculated with the inverse-variance weighted (IVW), penalized weighted median and weighted median. MR-Egger regression was used to explore pleiotropy.@*RESULTS@#No significant causal association of genetically determined CRP level with ischemic stroke, atrial fibrillation or arrhythmia was found with all four MR methods (all Ps > 0.05). The IVW method indicated suggestive evidence of a causal association between CRP and congestive heart failure ( OR: 1.337, 95% CI: 1.005-1.780, P = 0.046), whereas the other three methods did not. No clear pleiotropy or heterogeneity were observed.@*CONCLUSIONS@#Suggestive evidence was found only in analysis of congestive heart failure; therefore, further studies are necessary. Furthermore, no causal association was found between CRP and the other three cardiovascular outcomes.
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Humans , C-Reactive Protein/metabolism , Cardiovascular Diseases/metabolism , Genetic Predisposition to Disease , Genotype , Japan , Mendelian Randomization Analysis , Polymorphism, Single Nucleotide , Risk FactorsABSTRACT
In this study, the toxicological/pharmacological research method of "quantity-weight-evidence" network was first proposed and practiced to supplement the existing methodology of network toxicology. We transformed the traditional qualitative network into a quantitative network in this study by attributing weights to toxic component content and target frequency, which improved the reliability of data and provided a research idea for the systematic safety evaluation and toxicological research of Chinese medicinal herbs. Firstly, 50% ethanol extract of Dysosma versipellis(DV) was administrated to rats via gavage and the potential hepatotoxic components were identified by serum pharmacochemistry. Then, the component targets were obtained from SwissTargetPrediction, PharmMapper and other online databases, and the target weights were given according to the relative content of components and target fishing frequency. Meanwhile, the targets of hepatotoxicity were predicted from online databases such as Comparative Toxicology Database(CTD) and GeneCards. Subsequently, protein-protein interaction analysis and KEGG pathway enrichment were performed with the STRING database. Finally, the quantitative network of "toxic components-weighted targets-pathways" was constructed. Eleven potential toxic compounds were predicted, including podophyllotoxin, podophyllotoxone, deoxypodophyllotoxin, and 6-methoxypodophyllotoxin. A total of 106 hepatotoxic targets and 65 weighted targets(e.g., Cdk2, Egfr, and Cyp2 c9) were identified. The results of Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment showed that these targets could act on PI3 K-AKT, MAPK, and Ras signaling pathways to play a role in inflammatory response and oxidative stress. However, traditional network toxicology showed that 51 targets such as AKT1, Alb, and Stat3 may lead to hepatotoxicity by mediating inflammation and cell proliferation. In conclusion, we proposed "quantity-weight-evidence" network toxicology in this study and used it to study the mechanism of DV-induced hepatotoxicity in rats. This study confirms the feasibility of this new methodology in toxicological evaluation and further improves the systematic evaluation of the safety of Chinese medicinal herbs.
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Animals , Rats , Chemical and Drug Induced Liver Injury/etiology , Drugs, Chinese Herbal/toxicity , Ethanol , Medicine, Chinese Traditional , Molecular Docking Simulation , Reproducibility of ResultsABSTRACT
Objective:To systematically assess the risk factors for acute pancreatitis in pregnancy (APIP) in China in recent 10 years.Methods:Acute pancreatitis, pregnancy, risk factors and clinical features were used as search terms. Case-control studies on APIP in China were retrieved by computer from PubMed, Cochrane Library, Embase, CNKI, Wanfang, VIP and Chinese Biomedical Literature Database from December 2011 to December 2021. RevMan 5.4 software was utilized for Meta analysis.Results:A total of 1525 APIP patients (645 severe cases and 880 mild cases) were included in 26 literatures. Meta analysis showed that early pregnancy, late pregnancy, hyperlipidemia and biliary etiology were the risk factors for APIP. In the early pregnancy, 4.22% of patients were in the severe group and 10.43% were in the mild group; In the late pregnancy, 81.95% of the patients were in the severe group and 69.72% were in the mild group. The causes of hyperlipidemia accounted for 52.16% in the severe group and 22.69% in the mild group. The causes of biliary disease accounted for 27.96% in the severe group and 41.71% in the mild group. All the differences of the above indicators between groups were statistically significant (all P value <0.05). The age at onset, body mass index, serum C-reactive protein and triacylglycerol levels of severe patients were higher than those of mild patients, and were positively correlated with the severity of APIP ( MD values were 0.99, 65.97, 1.33, 6.44, 95% CI values were 0.03-1.96, 0.59-2.08, 23.43-108.50, 4.49-8.39, P values were 0.04, 0.0005, 0.002, <0.001). The levels of blood calcium and serum albumin were lower than those of mild patients, and were negatively correlated with the severity of APIP ( MD values were -0.37, -5.93, 95% CI values were -0.50--0.24, -9.11--2.75, P values were <0.001, 0.003). Conclusions:Acute pancreatitis can occur in all stages of pregnancy. Early pregnancy is mainly mild, and severe cases are more common in late pregnancy. Hypertriglyceridemic pancreatitis progresses rapidly, and tends to become more severe in China.
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OBJECTIVE@#To investigate clinical efficacy and safety of single and double segmental percutaneous lumbar discectomy for young and middle-aged patients with double-segment disc herniation.@*METHODS@#Retrospective analysis was undertaken for 32 young and middle-aged patients with percutaneous endoscopic lumbar discectomy (PELD) in the treatment of double-segment lumbar disc herniation from January 2015 to October 2018 in Peking University First Hospital. In the study, 18 cases were treated with single-segment treatment and 14 cases with double-segment treatment. Visual analogue score (VAS) and oswestry disability index (ODI) assessment were used to compare clinical symptom outcomes before surgery, 3 months after surgery and at the last follow-up. Macnab criteria were used to assess the patients' overall satisfaction after surgery. Imaging parameters included lumbar lordosis, intervertebral height at each segment and endplate angle of lesion segment on the X-ray. And Michigan State University(MSU) rating and Pfirrmann scoring system were used to evaluate the grade of disc herniation and disc degeneration respectively on magnetic resonance imaging (MRI). The perioperative parameters included the surgeon, anesthesia method, operation time, postoperative hospital stay, postoperative bracing time and perioperative complications.@*RESULTS@#The mean follow-up time was (26.78±10.64) months. There was no significant difference in the follow-up time and baseline information between the two groups(P > 0.05). ODI scores 3 months post-operatively and at the last follow-up were lower in the double segment (P < 0.05). The ODI improvement was also more significant in the double-segment group at the last follow-up (P < 0.05). There was no significant difference in radiographic parameters at baseline (P>0.05). MSU scale for the primary segment was significantly lowered after both operations (P < 0.05). MSU scale for secondary segment was significantly lowered in double segment group but not in single segment group. Other imaging parameters were similar between the two groups (P > 0.05). The operation time of the single-segment group was significantly shorter than that of the double-segment group(P < 0.001). No perioperative complications were found in either group, but three patients underwent secondary lumbar surgery during the postoperative follow-up period in the single-segment group.@*CONCLUSION@#For young and middle-aged patients with double-segment disc herniation, this study suggests double-segment PELD may be more advantageous than single-segment PELD in terms of asuring clinical efficacy without increasing perioperative risks.
Subject(s)
Humans , Middle Aged , Diskectomy , Diskectomy, Percutaneous , Endoscopy , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Spinal cord magnetic resonance imaging (MRI) is an advanced imaging technique (mainly in the cervical cord) and has been gradually used in basic scientific research such as human sensation and motor function, and clinical applications such as spinal cord injury, myelitis, and chronic pain, etc. The development of spinal cord MRI is still at the early stage compared with brain MRI and limited by the current MRI technology and data analysis methods. This review focuses on the methods and applications of spinal cord MRI technology in the basic research fields of cognitive neuroscience and clinical application. Firstly, we will introduce the imaging principle, methods, measurement standards, and applications of most commonly used multimodal spinal cord MRI techniques, including quantitative spinal cord MRI (such as structural, diffusion, spectroscopy, myelin water, magnetization transfer, and chemical exchange saturation transfer imaging, etc.) and spinal functional MRI (fMRI). Secondly, we will discuss the technical challenges and possible solutions of spinal cord MRI data processing from the three dimensions of denoising, data processing pipeline optimization, and repeatability and reliability. Finally, we will discuss the application status and development prospects of spinal cord MRI.
Subject(s)
Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Reproducibility of Results , Spinal Cord/diagnostic imaging , Spinal Cord InjuriesABSTRACT
Objective:To investigate the clinical efficacy of Da Vinci robotic assisted and laparos-copic assisted complete mesocolic excision (CME) for right hemicolon cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopatho-logical data of 119 patients with right hemicolon cancer who were admitted to Daping Hospital, Army Medical University from July 2016 to July 2019 were collected. There were 63 males and 56 females, aged (61±11)years. All the 119 patients underwent CME of right hemicolon. Of 119 patients, 37 cases undergoing Da Vinci robotic assisted CME of right hemicolon were divided into robotic group and 82 cases undergoing laparoscopic assisted CME of right hemicolon were divided into laparoscopic group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2)intraoperative and postoperative situations; (3) postoperative pathological examination; (4)follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect tumor metastasis and survival of patients after surgery up to August 2019. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Count data were represented as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Kaplan-Meier method was used to calculate survival rate and the GraphPad Prism 5 software was used to draw survival curve. The Log-rank test was used for survival analysis. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 68 of 119 patients had successful matching, including 34 cases in each group. Before propensity score matching, cases undergoing surgery by surgeon A or surgeon B were 32, 5 of the robotic group, versus 49, 33 of the laparoscopic group, showing a significant difference between the two groups ( χ2=8.381, P<0.05). After propensity score matching, the gender (males or females), age, body mass index (BMI), cases with tumor classified as stageⅠ, stage Ⅱ or stage Ⅲ of TNM staging, cases with tumor located at ileocecal region, ascending colon, hepatic flexor of colon or transverse colon, cases undergoing surgery by surgeon A or surgeon B were 17, 17, (62±10)years, (22.4±2.7)kg/m 2, 4, 14, 16, 3, 15, 10, 6, 29, 5 of the robotic group, versus 15, 19, (62±11)years, (22.4±2.8)kg/m 2, 4, 18, 12, 2, 19, 7, 6, 30, 4 of the laparoscopic group, showing no significant difference between the two groups ( χ2=0.236, t=0.127, 0.044, χ2=1.071, 1.200, 0.000, P>0.05). (2) Intraoperative and postoperative situations: after propensity score matching, the operation time, volume of intraoperative blood loss, cases undergoing conversion to open surgery, time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial liquid food intake, duration of postoperative hospital stay and treatment expenses were (235±50)minutes, (73±45)mL, 0, (1.9±0.7)days, (2.9±1.2)days, (3.1±2.4)days, (9.1±4.9)days, (9.6±1.8)×10 4 yuan of the robotic group, versus (183±35)minutes, (74±74)mL, 1, (2.1±0.6)days, (3.3±1.4)days, (3.5±4.2)days, (9.1±3.9)days, (6.3±1.6)×10 4 yuan of the laparoscopic group, respectively. There were significant differences in the operation time and treatment expenses between the two groups ( t=5.050, 8.165, P<0.05) while there was no significant difference in the volume of intraoperative blood loss, time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial liquid food intake or duration of postoperative hospital stay between the two groups ( t=0.118, ?0.462, ?1.129, ?1.291, 0.027, P>0.05). There was no significant difference in the conversion to open surgery between the two groups ( P>0.05). Five patients of the robotic group and 7 patients of the laparoscopic group had postoperative complications. There was no significant difference in the postoperative complications between the two groups ( χ2=0.405, P>0.05). (3) Postoperative pathological examination: after propensity score matching, cases with R 0 resection, the number of lymph node dissected, cases with lymph node metastasis and cases with tumor differentiation as well differentiated adenocarcinoma, moderately differentiated adeno-carcinoma, poorly differentiated adenocarcinoma or mucinous adenocarcinoma were 34, 17±5, 14, 1, 22, 6, 5 of the robotic group, versus 34, 17±5, 12, 2,20, 2, 10 of the laparoscopic group, respectively. There was no significant difference in the R 0 resection between the two groups ( P>0.05) and there was no significant difference in the number of lymph node dissected, lymph node metastasis and tumor differentiation between the two groups ( t=0.488, χ2=0.249, 4.095, P>0.05). (4) Follow-up: after propensity score matching, 68 patients were followed up for 1?36 months, with a median follow-up time of 24 months. The follow-up time was (20±13)months of the robotic group, versus (21±13)months of the laparoscopic group, showing no significant difference between the two groups ( t=0.409, P>0.05). During the follow-up, 3 cases of the robotic group and 4 cases of the laparoscopic group had tumor distant metastasis. The disease-free survival rate and overall survival rate at postoperative 3 years were 83.9% and 86.8% of the robotic group, versus 82.0% and 86.6% of the laparoscopic group, showing no significant difference between the two groups ( χ2=0.188, 0.193, P>0.05). Conclusion:Da Vinci robotic assisted CME for right hemicolon cancer is safe and feasible.
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Objective To investigate the risk factors of anastomotic leakage after transanal total mesorectal excision.Methods Retrospective analysis of clinical data of 46 patients with rectal cancer who underwent TaTME surgery from May 2015 to May 2018 in Daping Hospital,Army Medical University.There were 22 males and 24 females,the median age was 61.2 (range from 40 to 79)years.To observe the correlation between perioperative factors and anastomotic leakage,including preoperative staging,operation time,bleeding volume,anastomotic approach,anastomotic height,intraoperative adverse events,and concurrent diseases.The software of SPSS 20.0 was adopted to analyze the above indicators.Results Among 46 patients with rectal cancer,38 were treated with TaTME combined with laparoscopic surgery,5 with robotic transanal combined with transabdominal surgery,and 3 with pure transanal total mesorectal excision.There were no deaths in the whole group.The incidence of postoperative anastomotic leakage was 13.0%,1 case of grade B and 1 cases of grade A anastomotic leakage,both accounting for 2.2% and 4 cases of grade C anastomotic leakage,accounting for 8.7%.Anastomotic leak discovery time average (9.8 ± 4.8) d.No anastomotic leakage occurred in 17 cases of ileostomy.Among them,diabetes mellitus,protective ostomy,blood loss ≥ 100 ml,BMI,height of anastomosis and total operation time were significantly correlated with anastomotic leakage.Conclusions In addition to the influence of the learning curve during TaTME surgery,obesity,diabetes,anastomotic height,intraoperative blood loss ≥ 100 ml,and prolonged total operation time are risk factors for anastomotic leakage.Ileal protective ostomy is valuable for reducing anastomotic leakage.
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OBJECTIVE@#To explore the feasibility and safety of Da Vinci robot-assisted transanal total mesorectal excision (taTME).@*METHODS@#From May 2017 to July 2018, six rectal cancer patients underwent Da Vinci robot-assisted taTME at our hospital. The clinical data and short-term follow-up results were retrospectively analyzed.@*SURGICAL PROCEDURE@#The patient was placed in a Trendelenburg lithotomy position and sutured with purse string 1-2 cm from the anus to the distal end of the tumor. A self-made platform for transanal surgery was installed and the robot was connected. The rectum was transected circumferentially 0.5 cm from the distal end of the purse. The robot entered the " holy plane" and separated upward between the visceral parietal fasciae to the level of the third sacrum posteriorly and the peritoneal refcection anteriorly. The abdominal trocar was repositioned and connected to the robot. Through the abdominal cavity, the Toldt space of the posterior sigmoid mesentery was entered, and the D3 lymph nodes were dissected proximally. Separation was performed distally to join the perineal approach. Specimen was pulled out from the anus and excised. The cut end of sigmoid colon was anastomosed with the distal rectum or anal canal. Operative status, postoperative pathology and short-term efficacy were analyzed. Mesorectum of specimen was evaluated as complete, near complete and incomplete according to the Nagtegaal criteria. Anastomotic leakage was evaluated according to the criteria developed by the International Rectal Cancer Research Group.@*RESULTS@#All the 6 patients received Da Vinci robot-assisted taTME and sigmoid-anal anastomosis. In the 6 patients, 3 were male and 3 female; mean age was (62.6±2.6) years old; body mass index was (20.5±3.0) kg/m; distance from tumor to anal edge was (39.4±12.0) mm; length of tumor was (33.6±9.2) mm. Four patients received neoadjuvant therapy before surgery. All the patients completed operations successfully without conversion to laparotomy perioperative, severe complications or death. The mean total operative time was (245.8±24.2) minutes; transition interval of two procedures was (21.2±2.6) minutes; time of transanal robotic dissection of mesorectum was (72.3±15.2) minutes; intra-operative blood loss was (86.7±59.9) ml; the height of anastomosis was (16.0±6.1) mm. There were no intra-operative complications including accidental hemorrhage or urethral injury in any patients. The length of the specimens was (177.0±33.3) mm, and the mesorectum was complete in 5 cases, and near complete in 1 case. The mean distal margin was (20.2±3.2) mm, and the proximal, distal and circumferential margins were all negative. Postoperative pathological staging: T0N0 in 1 case, T0N1 in 1 case , T2N0 in 2 cases , T4N1 in 1 case, T3N0 in 1 case. The former 5 cases received clear fluit diet on the first day, and received fluid diet on the second day after operation. The drainage tube was removed 3 to 6 days after operation. The postoperative hospital stay was 5 to 7 days. The sixth case developed grade B anastomotic leakage on the third day after operation and healed by conservative treatment. No postoperative death, and no serious complications such as intra-abdominal hemorrhage, intestinal obstruction were found. All the patients were followed up for 5 to 19 months, and no local recurrence and death were observed.@*CONCLUSION@#The robotic system is safe and feasible for taTME procedure in rectal cancer with good short-term efficacy. However, the long-term outcomes require further observation.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Rectal Neoplasms , Rectum , Retrospective Studies , Robotic Surgical ProceduresABSTRACT
Since the reform and opening up, a large number of migrant workers to enter into the mining enterprises of the town, due to poor working conditions and lack of awareness of labor protection, a large number of workers at that time were diagnosed with occupational diseases such as pneumoconiosis, the lack of effective treatment and compensation mechanisms, it faces many difficulties of life, health care, employment and marriage, becoming more vulnerable, need access to national and social support and assistance. Currently, the patient's occupation of social assistance there are some flaws, and for the growing demand for professional rescue patients, China is still not established specifically for the social assistance system of the patient career, but also lack of systematic research. The paper combing through social assistance in the form and content of the existing occupation for patients and found deficiencies and problems of the current social assistance vocational patient exists, and proposed a framework for the establishment of vocational social assistance system of the patient, specific measures and means.
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Objective: To observe the clinical efficacy of Jinlida (JLD) granules and Tongxinluo (TXL) capsules on type 2 diabetic kidney disease (DKD) under the guidance of vessel collateral theory. Method: A total of 120 patients with type 2 DKD, were randomly divided into 2 groups:the normal control group (60 cases) and the treatment group (60 cases). The patients in normal control group were treated with dietary control and hyperglycemia control. Based on treatment in control group, patients in treatment group were additionally treated with JLD granules (1 bag, tid), and TXL capsules (4 capsules, tid). The treatment was lasted for 12 weeks. The clinical efficacy, traditional Chinese medicine(TCM) syndrome scores were observed and compared before and after treatment. At the same time, the levels of glucose metabolism indexes including fasting blood glucose (FBG),postprandial 2 h plasma glucose (2 hPG), glycosylated hemoglobin (HbA1c) and the insulin resistance (IR); the levels of lipid metabolism indexes including total cholesterol(TC),triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and the high-density lipoprotein cholesterol (HDL-C); the levels of renal function indexes including urinary albumin excretion rate (UAER) and serum creatinine (SCr); as well as nailfold microcirculation were detected and compared. Result: ①The total effective rate was 80.0% in treatment group, significantly higher than 61.67% in the normal control group (PPPPPβ2-MG in treatment group was significantly obvious than that in the control group (PPConclusion: Tongxinluo combined with Jinlida can improve the clinical symptoms of patients with type 2 diabetic nephropathy and reduce urinary trace albumin, and its mechanism may be related to lowering glucose, regulating lipid metabolism and improving microcirculation.
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Objective: To study the accumulation of mercury in liver, kidney and brain of rats and its toxicity on liver and kidney after 4 weeks of administration of different doses of Zhuhong ointment, in order to provide data reference for the safe clinical use of Zhuhong ointment. Method: Forty-four Sprague-Dawley (SD) rats were randomly divided into 4 groups:control group, normal-dose group (1.875 mg·kg-1), medium-dose group (37.5 mg·kg-1), and high-dose group (75 mg·kg-1). After transdermal administration for consecutive 4 weeks, the mercury content in the urine, blood, liver, kidney and brain of the rats was measured. In addition, serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), serum urea nitrogen (BUN), and serum creatinine (SCr), urine β2-miSCroglobulin (β2-BMG) and urine N-acetyl-beta-D glucosidase (NAG) contents were measured, and pathological morphology changes of liver and kidney were observed. Result:Compared with the control group, the levels of blood mercury and urine mercury in Zhuhong ointment groups showed significant increases after administration for 4 weeks(PPPPPPConclusion:Zhuhong ointment is not toxic at the normal dose, but long-term use can lead to the accumulation of mercury in liver, kidney and bra, which causes liver and kidney toxicity. This study did not find a more sensitive indicator of liver and kidney toxicity than liver and kidney pathology. However, because the rising levels of urinary mercury and blood mercury may predict toxicity, the relationship between mercury exposure and toxicity could be further studied. This study provides a reference for the rational use and toxicity monitoring of Zhuhong ointment.
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OBJECTIVE: To explore the feasibility and value of using three-dimensional CT reconstruction to evaluate the inferior mesenteric artery(IMA) classification and its characteristics in rectal cancer patients.METHODS: The clinical data of 108 rectal cancer patients admitted in Department of General Surgery, Daping Hospital of Army Military Medical University from January 2017 to November 2018 were analyzed retrospectively. The IMA images obtained by three-dimensional CT reconstruction before the operation were reviewed,the IMA was typed according to the different characteristics of IMA branches, and compared and analyzed the differences and characteristics of each IMA type. The length of IMA and the distance from the root of IMA to the bifurcation of the abdominal aorta were measured,and their associations with clinical features were analyzed.RESULTS: Of the 108 cases,60 were male and 48 were female. The IMA was classified into four types, of which 53(49.1%)were type Ⅰ,24(22.2%)were type Ⅱ,18(16.7%)were type Ⅲ,and 13(12%)were type Ⅳ. Univariate ANOVA showed that there were no statistically significant differences in age,BMI,LIMA,DIMA,number of positive lymph nodes,intraoperative blood loss and postoperative hospital stay among the patients with different IMA types(P>0.05). However,there was a statistically significant difference in IMA length between type II and type I or type Ⅲ(P=0.022 and 0.011,respectively). The average IMA length(LIMA)was(5.7±2.0)cm,and the average distance(DIMA)between the root of IMA and the bifurcation of the abdominal aorta was(6.3±2.3)cm.CONCLUSION: Three-dimensional CT angiography can be used before radical resection of rectal cancer to obtain the types of IMA branches and their pathways,so as to provide guidance for the treatment of IMA and preservation LCA in radical resection of rectal cancer.
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OBJECTIVE: To understand the exposure of occupational hazards, occupational and mental health status of high-speed railway locomotive drivers. METHODS: A total of 150 male high-speed railway locomotive drivers from Nanchang Railway administration were selected as experimental group, and 80 male ordinary train drivers were selected as control group by using a judgment sampling method. The occupational disease hazard testing and occupational health examinations were conducted in drivers of these two groups. The mental health status survey was conducted using the Symptom Checklist 90(SCL-90). RESULTS: The noise, power frequency electric field, formaldehyde, benzene, toluene, xylene and carbon dioxide in all the work place of these two groups were in line with the national occupational health standards. The exposure noise intensity of the experimental group was lower than that of the control group [(70.5±3.7) vs(77.4±4.1) dB(A), P<0.05]. The detection rates of hypertension and chronic gastritis were higher in the experimental group(18.7% vs 34.7%, 26.2% vs 42.0%, P<0.05). The detection rate of high frequency hearing loss decreased in the experimental group compared with the control group(22.5% vs 10.7%, P<0.05). The total score of SCL-90 in the experimental group was higher than that in the control group [(169.5±6.1) vs(148.0±6.0) score, P<0.01]. The positive rate of psychological symptoms was higher in the experimental group than that of the control group(41.3% vs 23.8%, P<0.01). CONCLUSION: The concentration/intensity of occupational disease hazards in the workplace of high-speed railway locomotives drivers is within normal limit. The occupational health status of high-speed railway locomotive drivers is generally good, but attention should be paid to their occupational mental health hazards.
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Objective To investigate the protective role of GPR35 inhibition on hypoxic myocardial cell line and mouse myocardial infarction (MI) model.Methods For investigating the changes of GPR35 expression in hypoxic environment,the murine myocardial cells (MCM) were divided into normoxia group and hypoxia group,the mRNA expression of GPR35 was determined by q-PCR and the protein level was measured by Western blotting 6h after incubation.For further studying the role of GPR35,MCM were divided into four groups:normoxia,hypoxia,hypoxia+vehicle,hypoxia+CID2745678 (GPR35 inhibitor,3μmol/L) group.Accordingly,the apoptosis of cardiomyocytes was measured by flow cytometer and TUNEL.For investigating the changes of GPR35 expression in the state of myocardial ischemia,the C57 male mice were divided into sham group (n=6) and MI group (n=8),the mRNA expression of GPR35 was determined by q-PCR and the protein level was measured by Western blotting 3 days after MI.For further studying the role of GPR35,the C57 mice were divided into four groups:sham (n=6),MI (n=8),MI+vehicle (n=8) and MI+CID2745678 (n=8) group.Ultrasound echocardiography was performed 4 weeks after MI.Mice were then sacrificed and the hearts were removed and stained with Masson to measure the myocardial fibrosis area.Results Compared with normoxia group,the levels of GPR35 mRNA and protein increased obviously in hypoxia group (P<0.01,P<0.05);Compared with hypoxia+vehicle group,the myocardial cells apoptosis in hypoxia+CID2745678 group decreased markedly (P<0.05).Three days after MI,compared with the sham group,the levels of GPR35 mRNA and protein increased obviously (P<0.01,P<0.05) in MI group;Compared with MI+vehicle group,the left ventricular fraction shortening (LVFS) and left ventricular ejection fraction (LVEF) relieved obviously (P<0.05) and myocardial fibrosis level declined markedly in MI+CID2745678 group (P<0.05).Conclnsion Inhibition of GPR35 could decrease the apoptosis of cardiomyocytes cultured in hypoxia and attenuated the injury of myocardial ischemia.