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Objective:To investigate the effect of transorally inserted anvil (OrVil TM) in patients with relapsed or denovo carcinoma at the esophagogastric junction. Methods:The clinical data of 60 patients who underwent radical intent resection for locally relapsed or denovo esophagogastric junction adenocarcinoma at Zhengzhou University Cancer Hospital from Jan 2011 to Jun 2021 were retrospectively analyzed. The patients were divided into two groups according to whether transorally inserted anvil was used. Twenty-six patients who had used the system were assigned to the experimental group. Thirty-four patients without transorally inserted anvil were set to control group.Results:The incisor distance of the experimental group was shorter than that of the control group [36(34-40)cm vs. 39(36-41)cm, Z=-4.948, P<0.05]. Operation time in experimental group was 177 (145-260) min, compared to control group of 172 (140-225) min ( Z=-0.735, P=0.463). Intraoperative blood loss was 200 (100-900) ml in the experimental group and 300 (100-800) ml in the control group ( Z=-1.244, P=0.213). Postoperative upper margin distance of the experimental group was (3.6±1.7) cm compared to control group of (1.8±1.1) cm ( t=-0.735, P<0.01). The positive rate of margin in the experimental group was 4% vs. 15% in the control group ( χ2=1.931, P=0.165). The length of postoperative hospital stay in the experimental group was (18.6±5.2) d vs. (20.5±4.7) d ( t=-1.455, P=0.151). Surgery-related complications developed in 19% in the experimental group vs. 27% in the control group ( P>0.05). Conclusion:The application of the transorally inserted anvil in the operation of patients with locally relapsed or denovo esophagogastric junction cancer after initial operation reduces the difficulty of operation and decreases the positive rate of margin.
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Object:To explore surgical treatments for duodenal fistula with intra-abdominal infection.Methods:The data of 19 patients with duodenal fistula treated at the Affiliated Tumor Hospital of Zhenzhou University between Jan 2015 and Dec 2021 were analyzed retrospectively. Surgery is performed with duodenostomy or modified duodenal shunt procedures.Result:All patients were accompanied by intra-abdominal infection, including 9 duodenal stump fistulas. All patients successfully completed the operation,11cases underwent duodenostomy, 8 case underwent modified duodenal shunt procedures. operating time was 110(60-140)min, postoperative hospitalization time was 29(9-103)d. Two patients died postoperatively. Fistula heals in other patients.Conclusion:Surgical intervention for duodenal fistula should focus on controlling the source of infection, strengthening intestinal and abdominal drainage, and reducing postoperative complications.
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Object:To investigate the impact of carbon nanoparticle tracing on the number of lymph nodes harvested in obese patients during radical gastrectomy for gastric cancer.Methods:Clinical data of 127 patients undergoing D 2 radical gastrectomy in the Affiliated Tumor Hospital of Zhengzhou University from Jan 2015 to Dec 2019 were retrospectively analyzed. According to whether the patients were injected with carbon nano particles during operation, they were divided into two groups: 64 patients without carbon nano particles during operation served as control group; 63 patients with carbon nano particles were included into experimental group. Results:The operation time of the control group was (160±31) min and that of the experimental group was (168±28) min ( t=-1.521, P=0.445). Intraoperative blood lose in the control group was (234±82) ml and that in the experimental group was (238±84) ml ( t=-0.295, P=0.846). The number of lymph nodes harvested in the first station, in the second station, the number of total lymph nodes and the number of lymph nodes with diameter <5 mm in the control group were less than those in the experimental group(10.4±3.8 vs. 24.5±10.6, t=-10.054),(6.6±2.8 vs. 16.8±7.3, t=-10.381),(17.1±6.4 vs. 41.2±17.6, t=-10.293),(3.9±2.5 vs. 21.2±9.1, t=-14.662) (all P<0.05), while the number of positive lymph nodes was not statistically different between the two groups all (5.9±6.2 vs. 4.2±3.4, t=-1.963, P>0.05). Black staining of lymph nodes in nano carbon group: 1 542 black stained lymph nodes were detected in the experimental group, the black staining rate of lymph nodes was 59.44% (1 542/2 594). Conclusion:Intraoperative application of carbon nanoparticles can significantly increase the number of harvested lymph nodes in obese (BMI≥25 kg/m 2) gastric cancer patients after radical resection.
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Objective:To compare the clinical characteristics and analyze the factors affecting vision prognosis of idiopathic macular hole (IMH) or myopic macular hole (MMH).Methods:A cross-sectional study. From October 2012 to October 2020, 336 patients with 346 eyes of IMH and MMH who were diagnosed in Shanxi Provincial Eye Hospital with continuous follow-up data after surgery were included. There were 346 eyes (336 cases), including IMH with 247 cases (255 eyes) and MMH with 89 cases (91 eyes), which were divided into IMH group and MMH group. Best corrected visual acuity (BCVA) and optical coherence tomography were performed in all eyes. The BCVA examination used the standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle of resolution (logMAR) visual acuity. The age of outset in IMH and MMH was 64.8±6.6 and 59.2±8.1 years, the logMAR BCVA was 1.11±0.50 and 1.80±0.78, respectively. There were significant differences in age ( Wald=34.507) and logMAR BCVA ( Z=-7.703) between two groups ( P<0.05). All eyes were performed inner limiting membrane (ILM) peeling or partial inverted ILM covering hole operation. After the operation, the vitreous cavity was filled with air, C 3F 8 and silicone oil, including 73, 102, 83 eyes in IMH group and 9, 10, 72 eyes in MMH group, respectively. Follow-up time after surgery was more than 2 months. The optimal BCVA and macular hole closure of the two groups were observed. If the quantitative data conformed to the normal distribution, the generalized estimating equation was used, otherwise, the Mann-Whitney U test or Kruskal-wallis test was used, the χ 2 test was used for the comparison of categorical variables. Generalized estimating equation logistic regression analyzed the influencing factors of optimal BCVA after surgery and visual acuity success. Results:In IMH and MMH, the optimal logMAR BCVA were 0.71±0.36, 1.10±0.51 respectively, and 147 (57.6%, 147/255) eyes, 63 (69.2%, 63/91) eyes achieved visual success respectively. There was a significant difference in the optimal logMAR BCVA ( Z=-6.803, P<0.005), but no difference in visual success rate ( χ2=3.772) between the two groups. The visual success rate of IMH at the same baseline BCVA level was higher than that of MMH, and the difference was statistically significant ( χ2=14.500, P=0.001). Logistic regression analysis showed that the influencing factors predicting poor optimal visual acuity after surgery were: IMH, baseline BCVA [odds ratio ( OR)=2.941, 95% confidence interval ( CI) 1.341-6.447, P<0.05], MH diameter ( OR=1.003, 95% CI 1.001-1.005, P<0.05), silicon oil filling ( OR=3.481, 95% CI 1.594-7.605, P<0.05); MMH, baseline BCVA ( OR=2.549, 95% CI 1.344-4.834, P<0.05), C 3F 8 filling ( OR=18.131, 95% CI 1.505-218.365, P<0.05) and silicon oil filling ( OR=7.796, 95% CI 0.997-60.944, P<0.05). The factors leading to a lower likelihood of achieving visual success: IMH, baseline BCVA ( OR=213.329, 95% CI 46.123-986.694, P<0.05), MH diameter ( OR=0.995, 95% CI 0.992-0.997, P<0.05), silicon oil filling ( OR=0.326, 95% CI 0.115-0.926, P<0.05) and duration ( OR=1.036, 95% CI 1.005-1.067, P<0.05); MMH, baseline BCVA ( OR=13.316, 95% CI 2.513-70.565, P<0.05) and duration ( OR=1.022, 95% CI 1.001-1.044, P<0.05). Conclusions:MMH was earlier than IMH in age of outset. Baseline vision significantly affected vision prognosis in IMH and MMH. Silicone oil should be avoided as much as possible under the premise of hole closure.
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Objective:To investigate the clinical significance of MRI dynamic enhancement in defining the upper edge of adenocarcinoma of esophagogastric junction.Methods:The clinical data of 73 patients with adenocarcinoma on the esophagogastric junction operated from Jul 2018 to Aug 2019 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. All patients underwent MRI examination within one week before surgery. First, the T 2WI, diffusion-weighted imaging and dynamic enhanced images of each patient were carefully observed to define the tumor location, size, shape, signal and enhancement mode, then the distances between the upper edge of the tumor and the cardiac incisure on MRI dynamic enhancement were measured independently, and compared with the measured distance in surgical fresh specimens. Results:The mean location of tumor upper edge measured in MRI of 73 patients was (1.75±1.98)cm, while measured in the surgical specimen was (1.72±1.97)cm. There was no significant difference between the two groups ( t=0.572, P=0.569). The intraclass correlation efficient between the two groups was excellent (ICC=0.974, 95% CI: 0.959-0.984, P<0.01). Conclusion:The measurement result of tumor upper edge in MRI is basically consistent with that of surgical specimens. MRI can be used to locate the tumor upper edge for adenocarcinoma of esophagogastric junction before operation.
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Objective:To investigate whether adjuvant chemotherapy could be beneficial for patients with pT1N1M0 (stage ⅠB) gastric cancer.Methods:From Jan 2010 to Dec 2016, 185 patients with pT1N1M0 gastric cancer who were surgically resected at Henan Cancer Hospital were retrospectively analyzed. The patients were divided into chemotherapy group ( n=100) and non chemotherapy group ( n=85). Results:For disease-free survival (DFS) analysis, univariate survival analysis showed that age, examined lymph nodes, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DFS (all P<0.05); multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.363, 95% CI: 0.160-0.827, P=0.016), vascular invasion ( HR=4.117, 95% CI: 1.796-9.436, P=0.001) and postoperative chemotherapy ( HR=4.530, 95% CI: 1.932-10.622, P=0.001) were independent risk factors for DFS. For disease-specific survival (DSS) analysis, univariate survival analysis showed that lymph node resection, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DSS; multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.344, 95% CI: 0.144-0.822, P=0.016), vascular invasion ( HR=5.113, 95% CI: 2.029-12.887, P=0.001) and postoperative chemotherapy ( HR=4.694, 95% CI: 1.854-11.888, P=0.001)were independent risk factors for DSS. According to examined lymph nodes and vascular invasion , pT1N1M0 patients were divided into three risk categories (high, medium and low). DFS and DSS were significantly different among the three risk groups (all P<0.001, respectively). Conclusion:pT1N1M0 gastric cancer patients are expected to benefit from adjuvant chemotherapy. Patients with less than 16 lymph nodes and vascular invasion may be particularly suitable for adjuvant chemotherapy.
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Objective:To evaluate a nano-carbon lymphatic tracing method for patients with rectal cancer after neoadjuvant radiotherapy and chemotherapy .Method:Retrospective analysis was made on 88 patients of rectal cancer undergoing neoadjuvant chemoradiation at the Department of General Surgery, He′nan Cancer Hospital from Jan 2016 to May 2020.According to whether nano-carbon lymph node was used or not, patients were divided into nanocarbon tracer group (study group) and non-nanocarbon tracer group (control group).Results:There was statistically significant in the number of havested lymph nodes between the two groups [15(11-19) vs.9(5-12), Z=5.227, P<0.001], There was no statistically significant in the number of positive lymph nodes between the two groups [0(0-0.25) vs.0(0-1), Z=1.199, P=0.231]. There were significant differences in the ratio of patients with less than 7 lymph nodes(0/34 vs.18/54, χ 2=14.248, P<0.001) and patients with less than 10 lymph nodes (4/34 vs.29/54, χ 2=15.657, P<0.001). Conclusions:The injection of nanocarbon after neoadjuvant chemoradiotherapy can increase the number of harvested postoperative lymph nodes and the ratio of patients with lymph nodes ≥7 and ≥10, which is more beneficial for prediction of the prognosis of patients.
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Objective:To investigate the application value of one-stitch prophylactic ileostomy in late ileostomy closure.Methods:The prospective randomized control study was conducted. The clinicopathological data of 141 patients with rectal cancer who underwent low anterior resection combined with prophylactic ileostomy in the Affiliated Tumor Hospital of Zhengzhou University from January 2016 to July 2020 were selected. There were 127 patients being selected after excluding 14 cases who did not undergo ileostomy closure. Patients undergoing one-stitch prophylactic ileostomy were divided into observation group, and patients undergoing traditional ileostomy were divided into control group. Observation indicators: (1) grouping situations of the enrolled patients; (2) surgical situations of ileostomy closure; (3) postoperative situations; (4) follow-up. Follow-up was conducted using outpatient examination and telephone interview once a month after low anterior resection combined with prophylactic ileostomy to detect complication and death of patients. The end point was at 3 months after ileostomy closure. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( P25, P75) or M (range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Results:(1) Grouping situations of the enrolled patients: a total of 127 patients were selected for eligibility, aged from 31 to 83 years, with a median age of 64 years. Of 127 patients, there were 66 cases in observation group and 61 cases in control group. (2) Surgical situations of ileostomy closure: all patients from the two groups underwent ileostomy closure successfully. The incision length, operation time, volume of intraoperative blood loss, cases with abdominal adhesion degree as slight adhesion or obvious adhesion were 4.25 cm(4.00 cm, 5.00 cm), 48.00 minutes(33.75 minutes, 58.00 minutes), 30 mL(20 mL, 50 mL), 34, 32 of the observation group, versus 7.50 cm(7.00 cm, 8.50 cm), 70.00 minutes(57.00 minutes, 80.00 minutes), 30 mL(30 mL, 50 mL), 13, 48 of the control group, showing significant differences between the two groups ( Z=-9.549, -6.133, -2.758, χ2=12.405, P<0.05). (3) Postoperative situations: cases with incision infection of the observation group and the control group were 5 and 13, respectively, showing a significant difference between the two groups ( χ2=4.917, P<0.05). (4) Follow-up: all the 127 patients were followed up for 6-21 months, with a median follow-up time of 10 months. During the follow-up, 3 cases of the control group had postoperative incisional hernia and were cured after conservative treatment. None of patient had anastomotic leakage related complications or died during the follow-up. Conclusion:The one-stitch preventive ileostomy has the advantage of ileostomy closure, which can reduce the operation time, volume of intraoperative blood loss and shorten the incision length effectively, so as to reduce the incidence of postoperative incision infection related complications.
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Objective:To evaluate the efficacy and perioperative safety of FLOT regimen in neoadjuvant chemotherapy for gastric adenocarcinoma.Methods:Data of 128 cases of neoadjuvant chemotherapy for gastric adenocarcinoma at the General Surgery Department of He′nan Cancer Hospital from Jan2018 to July 2019 were divided into FLOT group and SOX/XELOX group.Results:The disease control rate in the FLOT group was 81%, while that in the SOX/XELOX group was only 60% ( P=0.040). In terms of TRG classification and ypT staging, the proportion of TRG0 / 1 in the FLOT group was 49%, which was significantly higher than 21% in the SOX / XELOX group ( P=0.001). In the FLOT group, ypT 0-4 was 2, 10, 8, 17 and 6, respectively, while in the SOX/XELOX group, ypT 0-4 was 1, 9, 15, 26 and 34, respectively, ( P=0.022). In the FLOT group, ypTNM stages Ⅰ, Ⅱ, and Ⅲ were 11, 20, and 12, respectively, while in the SOX/XELOX group, ypTNM stages Ⅰ, Ⅱ, and Ⅲ were 12, 30, and 43, respectively ( P=0.040). Complications occurred in 10 patients (23%) in the FLOT group and 18 patients (21%) in the SOX/XELOX group ( P>0.05). Conclusions:FLOT neoadjuvant chemotherapy for advanced gastric adenocarcinoma does not increase the incidence of perioperative complications while effecting tumor regression and downstaging compared to SOX/XELOX regimen.
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Objective:To evaluate a new nano-carbon lymphatic tracing method to increase the number of lymph nodes acquired in patients with neoadjuvant chemotherapy for gastric cancer.Method:From Jan 2015 to Mar 2016, 159 patients with gastric cancer were recruited including 66 cases in study group receiving nano carbon injection under the mucosa layer one day before the operation, and 93 cases with intraoperative subserosal layer injection as control.Results:The average number of lymph nodes obtained in the study group was 47.0±14.7, while that in control was 38.0±14.5, P<0.05. The number of fibrotic lymph nodes obtained in the study group was 3.1 ± 1.9, compared with 3.0±1.8 in control, P>0.05. The number of black-stained lymph nodes in the former was 22.3±4.4, and the later was 14.7±4.8, P<0.05. The lymph nodes harvested in the first station in study group was 26.6±8.5, while that in the control group was 24.1±9.9, P>0.05. The lymph nodes obtained in the second station was 20.4±6.9 in study group, while in control was 13.8±5.7, P<0.05. Conclusions:The submucosal injection of nanocarbon one day before surgery increase the number of lymph nodes obtained in gastric cancer patients with neoadjuvant chemotherapy.
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Objective:To investigate the effects of preoperative endoscopic mucosal injection of carbon nanoparticle tracer and intraoperative serosa injection of carbon nanoparticle tracer on the acquisition of lymph nodes in total gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinical data of 118 patients with gastric cancer who underwent total gastrectomy in the Affiliated Tumor Hospital of Zhengzhou University between May 2017 and April 2018 were collected. There were 79 males and 39 females, aged from 26 to 81 years, with an average age of 59 years. Of 118 patients, 56 patients undergoing preoperative endoscopic mucosal injection of carbon nanoparticle tracer were divided into observation group and 62 patients undergoing intraoperative serosa injection of carbon nanoparticle tracer were divided into control group. Observation indicators: the total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station and the number of lymph node dissected at the second station. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent-sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Results:The total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station, the number of lymph node dissected at the second station of the observation group were 48±16, 3(range, 0-25), 26±9, 23±7, respectively. The above indicators of the control group were 41±13, 4(range, 0-28), 25±8, 16±5, respectively. There were significant differences in the total number of lymph node dissected and the number of lymph node dissected at the second station between the two groups ( t=2.494, 6.588, P<0.05), and there was no significant difference in the number of positive lymph node dissected and the number of lymph node dissected at the first station between the two groups ( Z=0.747, t=1.689, P>0.05). Conclusions:Carbon nanoparticle labeled lymph node staining using preoperative endoscopic mucosal injection of carbon nanoparticle tracer or intraoperative serosa injection of carbon nanoparticle tracer is safe and effective in total gastrectomy for gastric cancer. Compared with intraoperative serosa injection of carbon nanoparticle tracer, preoperative endoscopic mucosal injection of carbon nanoparticle tracer can increase the total number of lymph node dissected, especially the number of lymph node dissected at the second station of gastric cancer.
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Objective: To investigate the characteristics of quantitative electroencephalogram (EEG) in patients with amyotrophic lateral sclerosis (ALS) and their relationship with cognitive impairment. Methods: We recruited 38 patients with ALS and 26 healthy controls. All the patients underwent quantitative EEG examination to obtain the relative power of each frequency band and calculate the slow wave ratio (δ+θ)/(α+β) as comparison indexes. Among them, 27 patients with ALS underwent the ECAS scale examination to assess their cognitive function. At the same time, 25 healthy controls underwent the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) to determine the cut-off of scale score. We compared the slow wave ratio in ALS patients with and without cognitive impairment according to the cut-off score. Results: The relative powers of δ and θ bands and slow wave ratios of quantitative EEG in ALS patients were significantly higher than those in healthy controls, and there was no significant difference in relative powers of α and β bands. In the comparison of slow wave ratios in different brain regions, the proportion of slow waves in the bilateral temporal-occipital regions and the right parietal areas was significantly higher than that in healthy controls. The slow wave ratio in the left temporal area was positively correlated with the course of ALS (correlation coefficient 0.405, P=0.05). The ECAS scale screening revealed that 33.3% of ALS patients had cognitive impairment. ALS patients with cognitive impairment had higher slow wave ratios in the frontal and temporal areas than patients without cognitive impairment. The ALS specific item score, ALS non-specific item score and the total score of ECAS were all negatively correlated with the slow wave ratios in the frontal and temporal areas. Conclusion: The changes of EEG activity in patients with ALS are mainly the increase of slow wave activity, which is significant in the temporal, parietal and occipital areas. The slow wave ratios in frontal and temporal areas of ALS patients are correlated with cognitive impairment.
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Objective To understand the rate on tobacco use and associated factors in junior middle school students in Shaanxi province.Methods We used a multi-stage stratified random sampling method to select students from 30 junior middle schools in 10 areas of Shaanxi province in 2013.All the participants completed a self-administered questionnaire.Results A total of 4 633 questionnaires were dispatched and 4 298 were qualified for further analysis.The current smoking rate of junior middle school students in Shaanxi was 6.5％,with rate in male (11.1％) higher than that of female students (1.7％).The current smoking rate of students in grade three (9.3％) was higher than those of students in grade one (3.5％) or in grade two (7.0％).The smoking rate of students with pocket money more than 31 Yuan per week was (10.0％) higher than those of students with pocket money less than 10 Yuan (4.6％) or 10-30 Yuan (6.3％) per week.Results from the logistic regression analysis showed that factors as:male,school located in the city,older age,with more pocket money,having smokers in the family and exposure to second hand smoking were high risk factors for current smoking.Conclusion Rate on current smoking was high in junior middle schools students in Shaanxi,suggesting that comprehensive intervention programs be developed to reduce the rate of tobacco use in junior middle school students.
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Objective To explore the clinical application value of carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients with sigmoid colon cancer who were admitted to the Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from December 2015 to June 2016 were collected.Among 40 patients undergoing radical resection of sigmoid colon cancer,20 using nanometer carbon lymph node staining combined with artery approach and 20 using the traditional lymph node sorting were respectively allocated into the observation group and control group.Observation indicators:(1) detection of the lymph node and pathological examination;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect adjuvant chemotherapy,tumor recurrence or metastasis and surgery-related complications up to June,2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with the t test.Comparisons of count data were analyzed using the chi-square test.The comparisons of ordinal data were analyzed using the nonparametric test.Results (1) Detection of the lymph node and pathological examination:40 patients underwent successful radical resection of sigmoid colon cancer.The lymph node sorting time,total and average numbers of lymph node sorting,total and average numbers of lymph node with diameter ＜ 5 mm,cases with lymph node number ＜ 12 and numbers of the first,second and third stations lymph nodes were respectively (13.1±2.4) minutes,522,28.0±7.0,152,8.6±2.5,0,13.7±3.6,9.5±2.5,4.7±1.2 in the observation group and (18.4±3.5) minutes,239,13.0±3.0,64,3.9± 1.7,6,6.1 ± 1.6,6.6± 2.2,2.5± 1.0 in the control group,with statistically significant differences between groups (t =14.562,24.872,19.256,x2 =4.902,t =14.368,10.026,8.210,P＜0.05).The total number of positive lymph node,positive rate of lymph node,metastasis rate of patients,total and average numbers of positive lymph node with diameter ＜ 5 mm and numbers of the first,second and third stations positive lymph nodes were respectively 82,0.22％±0.13％,17/20,51,3.9± 1.9,4.2± 1.8,1.9±0.6,2.3± 1.2 in the observation group and 43,0.48％±0.18％,7/20,38,2.7±1.5,2.1±0.6,2.6±0.7,1.4±0.5 in the control group,showing no statistically significant difference in the positive rate of lymph node and number of the third station positive lymph nodes between groups (t =1.462,1.759,P＞0.05).There were statistically significant differences in the metastasis rate of patients,average number of positive lymph nodes with diameter ＜ 5 mm and numbers of the first and second stations positive lymph nodes between groups (x2 =10.417,t =7.264,4.682,3.410,P＜0.05).(2) Follow-up situations:40 patients were followed up for 12-18 months,with a median time of 16 months.Eighteen and 10 patients in the observation group and control group received postoperative adjuvant chemotherapy,showing a statistically significant difference between groups (x2=5.833,P＜ 0.05).Tumor recurrence or metastasis was respectively detected in 0 and 2 patients (1 with local recurrence and 1 with liver metastasis) in the observation group and control group,with no statistically significant difference between groups (x2=2.105,P＞ 0.05).During the follow-up,there was no surgery-related complication.Conclusion The carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer can increase the sorting rate and number of lymph node,and improve the accuracy of postoperative pathological staging.
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Objective To understand the rate on tobacco use and associated factors in junior middle school students in Shaanxi province.Methods We used a multi-stage stratified random sampling method to select students from 30 junior middle schools in 10 areas of Shaanxi province in 2013.All the participants completed a self-administered questionnaire.Results A total of 4 633 questionnaires were dispatched and 4 298 were qualified for further analysis.The current smoking rate of junior middle school students in Shaanxi was 6.5％,with rate in male (11.1％) higher than that of female students (1.7％).The current smoking rate of students in grade three (9.3％) was higher than those of students in grade one (3.5％) or in grade two (7.0％).The smoking rate of students with pocket money more than 31 Yuan per week was (10.0％) higher than those of students with pocket money less than 10 Yuan (4.6％) or 10-30 Yuan (6.3％) per week.Results from the logistic regression analysis showed that factors as:male,school located in the city,older age,with more pocket money,having smokers in the family and exposure to second hand smoking were high risk factors for current smoking.Conclusion Rate on current smoking was high in junior middle schools students in Shaanxi,suggesting that comprehensive intervention programs be developed to reduce the rate of tobacco use in junior middle school students.
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Objective To evaluate a novel lymph node (LN) sorting method on surgical resected sample guided by nanometer carbon staining and principle following the supplying artery tributory in rightsided colon carcinoma.Methods From May 2015 to June 2016,51 patients were randomly divided into two groups adopting traditional LN sorting method and that of a combination of nanometer carbon and artery guided.The final LN status were compared between the 2 groups.Results The total LN number and the positive LN in novel method group were higher than control group (437 vs.349,70 vs.54).The dissection time used,the number of harvested positive LN that was ＜ 5 mm were significantly different [(13.1 ± 3.2) minvs.(17.8 ±3.8)min,t=4.75,P=0.000;1.0±l.0vs.0.2 ±0.6,t=3.51,P=0.000].The number of patients with harvested LN less than 12,the rate of positive lymph nodes,the rate of metastasis were not significantly different (all P ＞ 0.05) between the two groups.Conclusions Use of nanometer carbon development combined with artery approach facilitates LN sorting,yielding more positive LNs,and increating the accuracy of pathological staging in right-sided colon cancer.
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Objective To investigate the vaginal microbilme characterization in women with human papillomavirus(HPV)16 and 18 infection and high-grade cervical intraepithelial neoplasia(CIN).Methods Three groups were set,including control group(without HPV infection and with colpitis),low-grade CIN group(with HPV 16 or/and 18 infection),and high-grade CIN group(with HPV 16 or/and 18 infection).Virginal microbial composition was determined by using 16S rRNA amplication sequencing and hierarchical clustering analysis among three groups was applied.Rank sum test was used to determine statistical significance.Results Diversity and complexity of bacteria was significantly elevated in high-grade group.Compared with the control,the growth of Lactobacillus crispatus(L.crispatus) and Lactobacillus casei(L.casei) was significantly decreased,while Lactobacillus iners(L.iners) was significantly increased in low-grade CIN group and high-grade CIN group,and both were proportionally correlated to the grade of the disease.Brucella canis(B.canis),as colonized bacteria,was significantly decreased in both low-grade and high-grade CIN groups,and the changes were proportional to the grade of disease.The growth of Dialistersuccinatiphilus(D.succinatiphilus),Gardnerella vaginalis(G.vaginalis) and Prevotellabivia(P.bivia) were significantly elevated and proportional to the grade of disease.Conclusion The diversity and complexity of virginal microbial composition could be significantly expanded in women with HPV infection and high-grade CIN.In contrast to the important role of lactobacillus in virginal health,L.inners could be pathogenic.The colonization of B.canis,D.succinatiphilus,G.vaginalis and P.bivia might be highly correlated with HPV chronic infection and further development of CIN.
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Objective To evaluate the result of early repair for urinary fistula caused by iatrogenic injury to ureter,bladder and urethra during resection of rectal cancer.Methods We retrospectively analyzed 26 cases of urinary fistula after resection of rectal cancer patients encountered in Department of General Surgery,Henan Tumor Hospital from October 2005 to May 2016.Urinary fistula was divided into four types according to the site of fistula.Results Surgery was performed ever after the diagnosis of the fistula was identified.In type Ⅰ fistula (6 cases of posterior urethral fistula) the treatment was stent placement and packing of the greater omentum.2 cases of bladder top fistula (type Ⅱ),were treated by fistula repair and cystostomy.Type Ⅲ involved 12 cases (bladder triangle fistula).The treatment was ureter stenting replantation,and cystostomy Type Ⅳ:ureteral fistula in 6 cases,the treatment was end-to-end anastomosis and stenting.After surgery 24 cases were cured and 2 cases (all of type Ⅲ fistula) ended up with permanent bilateral ureterocutaneostomy.Conclusion It is safe and effective to make early remedy repair for ureter,bladder and urethral fistula iatrogenically during rectal cancer resection.
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Objective To investigate the application value of the curved cutter stapler device combined with trans-orally inserted anvil (OrVil) in the radical resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 206 patients with Siewert type Ⅱ AEG who were admitted to the Henan Tumor Hospital between March 2011 and March 2016 were collected.All the 206 patients underwent radical resection and 3-step clock wise total gastrectomy + D2 lymph node dissection.Observation indicators:(1) surgery and postoperative recovery situations:surgical approach,overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,postoperative complications and duration of postoperative hospital stay;(2) postoperative pathological examination and chemotherapy;(3) follow-up and survival situations.Follow-up using telephone interview and outpatient examination was performed to detect tumor-free survival of patients up to April 2016.Measurement data with normal distribution were represented as x±s.The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgery and postoperative recovery situations:all the 206 patients received successful operations,including 85 with abdominal operation,50 with abdominal incision through the diaphragmatic muscle into thoracic surgery and 71 with thoracic-abdominal surgery.Overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation and duration of hospital stay were (113.7± 15.4)minutes,(3.5± 1.2)minutes,(10.4±2.9)minutes,(128±25) mL,32± 6,(2.4 ± 0.9) days and (12.3 ± 1.9) days,respectively.Of 206 patients,15 with postoperative complications were cured by conservative treatment,including 6 with implicit anastomotic fistula,3 with dominant anastomotic fistula,2 with pancreatic leakage,2 with intestinal obstruction,1 with anastomotic stenosis and 1 with thoracic and abdominal infection.There was no reoperation due to perioperative complications.(2) Postoperative pathological examination and chemotherapy:postoperative pathological results showed that distance from resection margin of the esophagus to tumor was (5.2±0.4) cm,without cancer cells in the resection margin.Among 206 patients,171 received postoperative chemotherapy by S1 single agent combined with oxaliplatin for 6-8 cycles or oral S1 single agent for 1 year.(3) Follow-up and survival situations:206 patients were followed up for (2.7± 0.3)years,with a tumor-free 3-year survival rate of 58％.During the follow-up,there was no recurrent anastomotic tumor.Conclusion The curved cutter stapler device combined with OrVil in the radical resection of Siewert type Ⅱ AEG can simplify the difficulty of esophagojejunal anastomosis and guarantee the safe resection margin of the lower esophagus.
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<p><b>OBJECTIVE</b>To explore the technical advantages of nano carbon development combined with artery approach in lymph node sorting of rectal cancer.</p><p><b>METHODS</b>From December 2015 to June 2016, 70 patients with of rectal cancer in General Surgery Department of Henan Cancer Hospital were randomly divided into nano carbon development combined with artery approach group(artery approach group) and conventional group. Specimen of artery approach group was placed on the sorting table. Anatomy was performed from the root of inferior mesenteric artery to left colonic artery, sigmoid artery and superior rectal artery. Along the arterial vessel shape, the black-stained lymph nodes and non-stained lymph nodes (perhaps pink, pale yellow, white or pale brown) were examined carefully using visual and haptic combination method for identification of lymph node. From the root of inferior mesenteric artery, central lymph nodes were sorted. Along the vessel shape, vascular lymph nodes were sorted. Intestinal lymph nodes around the rectum were examined as well. Then, specimen was reversed on the sorting table and underwent sorting as above after the examination of obverse. The conventional group received routine method. The total number, the average harvested number, the number of positive lymph nodes and the number of patients with lymph nodes less than 12 were compared between two groups.</p><p><b>RESULTS</b>Among 70 cases, 37 were male and 33 were female with the median age of 57(32-88) years old. Dixon resection was performed in 46 cases, and Miles resection in 24 cases. Total sorting lymph node was 1 105, including 641 of artery approach group and 464 of control group with significant difference (t=20.717, P=0.000). Lymph node sorting time of artery approach group was (12.6±3.9) minutes, which was shorter than (18.2±4.1) minutes of control group (t=12.464, P=0.000). In artery approach group, number of lymph node with diameter less than 5 mm was 142, sorting rate was 22.2%(142/641), of which 29 were positive(20.4%). In conventional group, 37 lymph nodes with diameter less than 5 mm were found, and sorting rate was 8.0%(37/464), of which 6 were positive(16.2%). Number of the first station of lymph node sorting in artery approach group and conventional group was 282(44%) and 169(36.4%); number of the second station lymph node sorting was 230(35.9%) and 180(38.8%); number of the third station lymph node sorting was 129(20.1%) and 115(24.8%).</p><p><b>CONCLUSION</b>The method of nano carbon development combined with artery approach in lymph node sorting of rectal cancer has some advantages, such as simple operation, more harvested lymph nodes, and more accurate pathological staging.</p>