Robot-assisted laparoscopic surgery for treatment of adrenal tumors in children / 中华实用儿科临床杂志

Objective:To explore the feasibility, efficacy and limitation of robot-assisted laparoscopic surgery in the treatment of adrenal tumors in children.Methods:The clinical data of 5 children with adrenal tumors treated with robot-assisted laparoscopic surgery in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from October 2020 to March 2021 were retrospectively analyzed. All patients were males aged between 2 years and 4 months to 13 years and 1 month (median: 7 years and 7 months). One case had left adrenal adenomas and 4 cases had right adrenal adenomas.The maximum diameter of tumors was 3.0-6.0 cm (median: 4.8 cm).Results:Robot-assisted laparoscopic adrenalectomy was performed successfully on all 5 patients.The ope-ration time was 215-325 min (median: 275 min). The intraoperative bleeding was 10-50 mL (median: 28 mL). The indwelling time of the drainage tube after surgery was 3-5 days (median: 4 days). The postoperative hospital stay was 9-13 days (median: 11 days). The hospitalization cost was 51 268-58 157 yuan (median: 53 485 yuan). No complications occurred during or after the operation.Postoperative pathological tests suggested adrenal cortex adenocarcinoma in 1 case, pheochromocytoma in 1 case, gangliocytoma in 2 cases, and ganglioneuroblastoma in 1 case.Conclusions:Robot-assisted laparoscopic surgery is safe and feasible in children with adrenal tumors, but there are some limitations.This approach needs to be verified by further clinical research.

Effect of remifentanil on MAPK signaling pathway during intestinal epithelial cell apoptosis induced by intestinal ischemia-reperfusion in rats / 中华麻醉学杂志

Objective:To evaluate the effect of remifentanil on mitogen-activated protein kinase (MAPK) signaling pathway during intestinal epithelial cell apoptosis induced by intestinal ischemia-reperfusion (I/R) in rats.Methods:Thirty-six clean grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, aged 2 months, were divided into 3 groups ( n=12 each) by a random number table method: sham operation group (Sham group), intestinal I/R group (I/R group) and remifentanil group (R group). Intestinal I/R was produced by occlusion of superior mesenteric artery for 1 h followed by reperfusion in anesthetized rats.At 30 min before ischemia, 0.2 μg·kg -1·min -1 of remifentanil was infused intravenously for 5 min , followed by infusion of normal saline for 5 min, repeating for 3 cycles in group R. At 2 h of reperfusion, blood samples were collected from right ventricle to measure the concentration of diamine oxidase (DAO). The animals were then sacrificed and the intestinal tissues were obtained for examination of pathological changes and scored according to Chiu, for calculation of intestinal epithelial cell apoptosis rate (by TUNEL), for determination of the expression of phosphorylated extracellular signal-regulated kinase (p-ERK), phosphorylated c-Jun N-terminal kinase (p-JNK), phosphorylated p38 MAPK (p-p38 MAPK), cleaved caspase-3 and nuclear factor kappa B p65 (NF-κB p65) in nucleoprotein and for calculation of p-ERK/ERK ratio, p-JNK/JNK ratio and p-p38 MAPK/p38 MAPK ratio in the intestinal tissues. Results:Compared with group Sham, Chiu′s scores, serum DAO concentration, apoptosis rate, p-ERK/ERK ratio, p-JNK/JNK ratio and p-p38 MAPK/p38 MAPK ratio and the expression of cleaved caspase-3 and NF-κB p65 in the intestinal tissues were significantly increased in group I/R, and Chiu′s scores was increased ( P<0.05), and no significant change was found in serum DAO concentration, apoptosis rate, p-ERK/ERK ratio, p-JNK/JNK ratio, p-p38 MAPK/p38 MAPK ratio and the expression of cleaved caspase-3 and NF-κB p65 in the intestinal tissues in group R ( P>0.05). Compared with group I/R, Chiu′s scores, apoptosis rate, serum DAO concentration, p-ERK/ERK ratio and expression of cleaved caspase-3 and NF-κB p65 were significantly decreased in group R ( P<0.05). Conclusion:The mechanism by which remifentanil inhibits intestinal epithelial cell apoptosis induced by intestinal I/R is related to promoting activation of ERK in rats.

Recent advances of MDM2-p53 inhibitors / 药学学报

Protein-protein interactions (PPI) are involved in a variety of biological processes, including cell-to-cell interactions, metabolism and development control. The misregulation, post-translational modification and interference of PPI are related to a variety of human diseases, making the regulation of these interactions a very attractive field of drug discovery. In recent years, the interaction between MDM2 and p53 has become a research hotspot, which plays an important role in the treatment of tumors. But unfortunately there are no such inhibitors approved all over the world. In this view, recent advances of MDM2-p53 inhibitors were briefly described and its inhibitors with potential therapeutic activities in clinical studies were introduced.

Discussion on controlling proportion of medical consumables / 医疗卫生装备

Objective To explore the method for controlling the proportion of medical consumables.Methods The objective and significance of controlling the proportion of medical consumables were introduced,and the method was analyzed from the aspects of bidding procurement,total control mechanism,administrative approval and involvement in department management by objectives.Results The effective management of medical consumables decreased irrationality and procurement price of medical consumables.Conclusion Controlling the proportion of medical consumables promotes public hospital reform and the economic burden of the patient.

Discussion on controlling proportion of medical consumables / 医疗卫生装备

Objective To explore the method for controlling the proportion of medical consumables.Methods The objective and significance of controlling the proportion of medical consumables were introduced,and the method was analyzed from the aspects of bidding procurement,total control mechanism,administrative approval and involvement in department management by objectives.Results The effective management of medical consumables decreased irrationality and procurement price of medical consumables.Conclusion Controlling the proportion of medical consumables promotes public hospital reform and the economic burden of the patient.

A prevalence study on occupational stress and hypertension among steel production workers / 中国职业医学

OBJECTIVE: To analyze the correlation between occupational stress and hypertension in steel production workers.METHODS: By the stratified cluster sampling method,1 580 steel production workers from an iron and steel group company were selected as study subjects. Occupational stress was measured by the Chinese version of Job Content Questionnaire.The identification of having occupational stress was the ratio of job requirement dimension score over job self-decision dimension score turned to be ≥1. 00. The steel production workers' blood pressure was measured by the updated mercury sphygmomanometer. The effect of occupational stress on blood pressure in steel production workers was analyzed. RESULTS: The dimension score of job self-decision in hypertension group was lower than that in non-hypertension group [20( 16,23) vs 20( 17,24) scores,P < 0. 05]. There was no statistical significant difference in occupational stress ratio,job requirement and social support dimension scores between two groups( P > 0. 05). The multiple logistic regression analysis showed that job self-decision and social support scores were negatively correlated with the incidence of hypertension [odds ratios( 95% confidence intervals) were 0. 68( 0. 51,0. 90) and 0. 54( 0. 45,0. 76),P < 0. 01]. CONCLUSION: Job selfdecision and social support are the influencing factors of the incidence of hypertension in steel production workers. The correlation among occupational stress,job requirement and hypertension are not found in steel production workers.

Coronary angiography of in vitro porcine heart using MSCT / 法医学杂志

OBJECTIVE@#To establish standardized methods and parameters of the isolated heart coronary angiography through the experiment of in vitro porcine heart by MSCT.@*METHODS@#Based on different perfusion volume (50, 60 and 70 mL) and different perfusion-imaging time (5, 10 and 20 min), the in vitro porcine coronary artery was injected liposoluble and water-soluble contrast agents using remodel angiography equipment and scanned by MSCT. And the 3D image results were compared. The images were recorded and evaluated by 2 radiologists and analyzed by statistical software.@*RESULTS@#Liposoluble contrast agent affected the images by damaging and infiltrating the fats around the coronary artery, while the water-soluble contrast agent didn't affect the images. The groups with 60 mL or 70 mL perfusion and 5 min perfusion-imaging time had the best images.@*CONCLUSION@#The suitable parameters of the angiography lay the foundation of postmortem coronary angiography.

Automated assessment of developmental levels of epiphysis by support vector machine / 法医学杂志

OBJECTIVE@#To realize the automated assessment of the levels of epiphysis of distal radius and ulna by support vector machine (SVM).@*METHODS@#The X-ray films of the left wrist joints were taken from 140 teenagers aged from 11 to 19 years old as training samples. The levels of epiphysis of distal radius and ulna were divided into five developmental levels. Each level contained 28 samples. Another 35 cases were selected as independent verifying samples. SVM classification models of the five developmental levels of epiphysis of distal radius and ulna were established. The internal cross validation was made by leave one out cross validation (LOOCV), while the external validation was made by histogram of oriented gradient (HOG), and then the accuracy (PA) of testing results was calculated, respectively.@*RESULTS@#The PA of SVM, LOOCV and HOG of distal radius epiphyseal level were 100%, 78.6%, and 82.8%, respectively; whereas the PA of SVM, LOOCV and HOG of distal ulna epiphyseal level were 100.0%, 80.0% and 88.6%, respectively.@*CONCLUSION@#The SVM-based automatic models of the growth stage of distal ra- dius and ulna appear to have certain feasibility, and may provide a foundation for software development of bone age assessment by forensic medicine.

The subtle anatomical structures of normal nasal bone in MSCT image and forensic identification / 法医学杂志

OBJECTIVE@#To summarize the subtle anatomical structures of the normal nasal bone in multi-slice spiral CT (MSCT) image through the observation of the three-dimensional images.@*METHODS@#One hundred and twenty volunteers who had no nasal trauma and disease history were collected. The nasal was scanned using MSCT. Raw data was reconstructed into bone window images (slice thickness 0.6 mm, slice interval 0.5 mm), and then the images were imported into Syngo Imaging XS software to reconstruct three-dimensional images and to summarize the nasal bone's subtle anatomical structures.@*RESULTS@#The subtle anatomy of normal nasal bone generally included four seams, two holes and one edge. The four seams were left and right nasal-maxillary suture, nasal-frontal seam, and internasal suture. The two holes were left and right nasal aperture. The edge of the nasal was the lower edge of the nasal bone. In addition, there was suture bone in internasal suture in some normal nose. The nasal aperture mostly was hole-like, but some nasal apertures were line shape. The nasal edge can be divided into flat type, wave-shaped type, inverted spike type, hook-shaped type and others.@*CONCLUSION@#The anatomy diversity and individual differences in nasal bone are large. MSCT and three-dimensional image reconstruction techniques, combined with the history of trauma could distinguish between the normal anatomy and fractures.

Application of MSCT's coronary artery calcification score in evaluation of sudden death caused by coronary artery disease / 法医学杂志

OBJECTIVE@#To access application value of multi-slice spiral computed tomography (MSCT) and coronary artery calcium scoring (CACS) in investigation the coronary artery disease (CAD), and to explore the effective way of virtual autopsy to evaluate the sudden death due to CAD.@*METHODS@#Nine cases of sudden cardiac death were collected to analyze MSCT before the autopsy. The quantitative analysis of the degree of coronary artery calcium was made by Agatston's method. The CACS of all the subjects were calculated based on the diagnostic criteria for CAD, in which calcium scoring was more than 400. The results of CACS were compared with that of the autopsy.@*RESULTS@#Only 2 cases got the high calcium scoring which were more than 400 in the 9 cases died of CAD confirmed by the autopsy. The prediction rate of CACS for CAD was only 22.2%. Pulmonary edema of different severity was found in both autopsy and MSCT. There was a higher morbidity rate in the left anterior descending of coronary artery than the other branches.@*CONCLUSION@#Obvious calcification of coronary artery can be detected by MSCT and calculating CACS. To detect subtle calcification needs other technologies such as postmortem angiography.

Mathematical models of the teenager's skeletal age evaluation based on CT scan and imaging reconstruction of medial clavicular epiphysis / 法医学杂志

OBJECTIVE@#To explore the correlation between CT volume rendering (VR) statistics and living age and to build the mathematical models for skeletal age evaluation based on the growth rules of medial clavicular epiphysis of teenagers in China.@*METHODS@#The thin layer CT scan and VR 3D imaging reconstruction of both sides of sternal ends of clavicles were examined for 684 teenagers aged from 15 to 25 in East and South China. The parameters of sternal end of clavicle including the longest diameter of epiphysis, the longest diameter of metaphysis, their length radio, area of epiphysis, area of metaphysic, their area ratio, and other data were measured and calculated in order to establish mathematical models of skeletal age evaluation. Fifty trained subjects were tested to verify the accuracy of the mathematical models.@*RESULTS@#In the same age group, the length ratio and the area ratio had significant difference in genders (P < 0.05). The established mathematical models showed that the growth rules of medial clavicular epiphysis were highly correlated with the living ages. The accuracies of these models were higher than 70.5% +/- 1.0 year) and 82.5% (+/- 1.5 year).@*CONCLUSION@#The mathematical models have easy operability and high accuracy. It can be used to confirm and sustain the conclusion of atlas method. Meanwhile, it is of great significance to study the other single skeletal age evaluation in the future.

Mathematical models for teenager's living age evaluation based on CT image of medial clavicular epiphysis / 法医学杂志

OBJECTIVE@#To explore the correlation between volume rendering (VR) statistics of medial clavicular epiphysis and living age, and establish the mathematical models for living age evaluation using the CT image of medial clavicular epiphysis based on the growth rules of osteoepiphysis of medial clavicle.@*METHODS@#The CT images of the medial clavicles from 795 teenagers aged 15-25, 387 males and 408 females, were collected in East and South China. VR 3D images were reconstructed from 0.60 mm-thick slice CT images. The epiphyseal diameter, sternal end diameter, and their respective diameter ratio (the left: X1; the right: x3); epiphyseal area, sternal end area, and their respective area ratio (the left: x2; the right: x4), were measured and calculated. All these observations were analyzed using SPSS 19.0 statistical software. The statistical differences in gender and age were analyzed by Mann-Whitney U test. The mathematical models were established using least square. Sixty trained subjects, 30 males and 30 females, were tested to verify the accuracy of the established mathematical models.@*RESULTS@#In the group of same age, x1 showed significant difference in gender; the same results were observed in x2, x3, and x4, which suggested that the growth rules of osteoepiphysis of medial clavicle were highly correlated with living age. The accuracy of these mathematical models were all above 67.6% (+/- 1.0 year) and 78.5% (+/- 1.5 year).@*CONCLUSION@#The mathematical models with reasonable accuracy could be manageable in practice to confirm the conclusion of the atlas method. The current study can contribute to the single skeletal age evaluation.

Bone development trend in the knee joint of Tibetan teenagers in Aba Prefecture of Sichuan Province / 法医学杂志

OBJECTIVE@#To discuss bone development trend in the knee joint of Tibetan teenagers in Sichuan province and to effectively update the database for estimating the living age of Tibetan teenagers in terms of bone age of the knee joint.@*METHODS@#Radiographs including epiphysis of distal femur, proximal tibia and proximal fibula were taken from 483 Tibetan male and female teenagers aged from 14 to 19 years old in Aba prefecture of Sichuan province in order to observe epiphyseal growth situation. The descriptive data of the epiphyseal closure ages of these teenagers' knee joints were statistically analyzed by SPSS 16.0 software.@*RESULTS@#The distal femur epiphyseal closure occurred earliest, while the proximal fibula epiphyseal closure occurred latest. The epiphyseal growth of knee joints of females occurred about one year earlier than that of males.@*CONCLUSION@#The forensic information and data related to Tibetan teenagers' bone age identification should be updated regularly. These results provide potential value for the practice of forensic medicine, anthropology and clinical medicine.

The staging method of sternal end of clavicle epiphyseal growth by thin layer CT scan and imaging reconstruction / 法医学杂志

OBJECTIVE@#To establish a CT staging method of sternal end of clavicle epiphyseal growth for teenagers by thin layer CT scan, multiplanar reconstruction (MPR) and volume reconstruction (VR) technologies.@*METHODS@#The CT imaging characteristics, which collected from 460 teenagers (aged from 15 to 25) in East and South China, were studied through both sternal ends of clavicles' imagings by thin layer coronal CT scan and axial CT scan, MPR and VR technologies. The parameters of sternal end of clavicle including the longest diameter of epiphysis, the longest diameter of metaphysis, their length ratio, area of epiphysis, area of metaphysis, and their area ratio were measured and calculated in order to establish new classification.@*RESULTS@#Based on the staging method of Schmeling, integrating the CT imaging reconstruction information of sternal end of clavicle, the new classification of sternal end of clavicle epiphyseal growth were divided into 1 to 5 stages, and stage 2 and stage 3, respectively, contained a, b and c sub-classification.@*CONCLUSION@#This new classification has merits of large sample size, wide age range and easy operability. By using CT imaging reconstruction techniques and analyzing the data which closely related to sternal end of clavicle epiphyseal growth of teenagers, the feasibility of the staging method could be increased.

Progress in thin layer CT scan technology in estimating skeletal age of sternal end of clavicle / 法医学杂志

It is practical value for determination the teenagers whether the age is full of the legal responsibility age of 18 years old or not by estimating skeletal age of sternal end of clavicle. The traditional methods mainly based on X-ray radiography. However, sternal end of clavicle and adjacent lung, bronchus, sternum, rib, transverse process of thoracic vertebra are overlapped each other. As a result of overlapping, there will be obtained false negative or positive film reading results when according to X-ray observation of epiphyseal growth of sternal end of clavicle, which directly affect the scientificalness and accuracy of estimating of skeletal age. In recent years, the scholars at home and abroad have started to use thin layer CT scan technology to estimate skeletal age of the sternal end of clavicle. With the 2D and 3D CT recombination technology, the accuracy of the film reading distinctly improves by making the shape, size and position of epiphysis displayed clearly. This article reviews the application and research progress of thin layer CT scanning technology in estimating skeletal age of sternal end of clavicle at home and abroad, analyzes the superiority and value of thin layer CT scan technology, which applied to skeletal age of sternal end of clavicle.

Assessment of a sudden death case due to coronary artery disease based on the PMCT and forensic autopsy / 法医学杂志

It is never an easy thing to diagnose heart vascular disease only depending on the unenhanced postmortem computed tomography (PMCT). This article reported a case of sudden natural death after the complaint of anterior chest pain in which coronary artery calcification (CAC) was clearly displayed using PMCT scan. The entire coronary artery system was almost reconstructed via multiplanar reformation (MPR) and volume-rendering reconstruction (VR), and the total calcium score of the coronary arteries was obtained with CaScoring automatic analysis software. The results showed that CAC was conspicuous; the total calcium score was 640.3, considerably higher than 400. The pulmonary ground-glass opacity (GGO) and small amount of fluid both in the subglottic trachea and main bronchi were also found. The imaging results confirmed those of autopsy. In addition, the results concluded that PMCT might serve as an invaluable adjunct to the classic autopsy procedure.

Long-term trend of bone development in the contemporary teenagers of Chinese Han nationality / 法医学杂志

OBJECTIVE@#To further improve the accuracy of bone age identification using the time of secondary ossification center appearance and epiphyseal fusion of 7 joints to estimate the age of living individuals.@*METHODS@#DR films were taken from 7 parts including sternal end of clavical and the left side of shoulder, elbow, carpal, hip, knee and ankle joints of 1 709 individuals who came from eastern China, central China and southern China, whose ages were between 11.0 and 20.0 years. From those 7 joints 24 osteal loci were selected as bone age indexes, which could better reflect age growth of teenagers. The characteristics of secondary ossification center appearance and epiphyseal fusion were observed, and the mean and age range of secondary ossification center appearance and epiphyseal fusion were calculated.@*RESULTS@#The fusion time of the 24 epiphyses were advanced at different degrees, the most obvious epiphyses the sternal end of clavicle, scapular acromial end, distal end of the radius, distal end of the ulna, iliac crest, ischial tuberosity, the upper and lower end of tibia and fibula. The appearance time of sternal end of clavicle, scapular acromial end, iliac crest and ischial tuberosity epiphyses were all found to be after the age of 12, and the female's age, approximately 1 year ahead of schedule in comparison with the male's.@*CONCLUSION@#The relevant forensic information and data for bone age identification should be updated every 10-15 years so as to provide accurate and objective evidence for court testimony, conviction and sentencing.

Analysis of variation of Han male adolescent bone development in Hainan, Henan and Zhejiang provinces / 法医学杂志

OBJECTIVE@#To study the difference of bone development of the Han male adolescents in Hainan, Henan and Zhejiang provinces.@*METHODS@#All radiographs including sternal end of clavicle, pelvis and six main bone joints taken from 877 Han male adolescents aged between 12.00 and 20.00 in Hainan, Henan and Zhejiang provinces were reviewed. Twenty-four indices of skeletal development were analyzed based on "The Grading Standards" of skeletal growth of teenagers and then the bone age were calculated using mathematical model functions. The ratios of the bone age and the chronological age were then analyzed by statistical software.@*RESULTS@#The development of Hainan male adolescents' skeleton were about 1.09 years and 1.26 years earlier than that in Henan and Zhejiang at the age group of 12.00-12.99 years. The development of Hainan male adolescents' skeleton were about 0.70 years and 1.38 years earlier than that in Henan and Zhejiang at the age group of 13.00-13.99 years, while the development of Henan male adolescents' skeleton were about 0.68 years earlier than that in Zhejiang in this age group. The development of Hainan male adolescents' skeleton were about 0.79 years later than that in Henan at the age group of 18.00-18.99 years. The development of Hainan male adolescents' skeleton were about 0.70 years and 0.95 years later than that in Henan and Zhejiang at the age group of 19.00-20.00 years.@*CONCLUSION@#There are significant differences in the skeleton development of Han male adolescents between the provinces of Hainan, Henan and Zhejiang. These results provide potential value for the practice of forensic medicine, anthropology and clinical medicine.

Totally laparoscopic Meckel' s diverticulectomy / 中华普通外科杂志

ObjectiveTo evaluate totally laparoscopic Meckel's diverticulectomy in comparison with laparoscopic-assisted or open diverticulectomy.MethodsThe clinical data of 58 cases of Meckel's diverticulum admitted between January 2006 and January 2011 were analyzed.Cases were divided into three groups according to different period of time. As a result,totally laparoscopic surgery was performed in 13 cases,laparoscopic-assisted resection in 25 cases and open diverticulectomy in 20 cases. Totally laparoscopic group was compared with the other two groups in operation time,flatus defecation time,the incidence of postoperative complications and postoperative hospital stay.ResultsThe mean length of incision was ( 1.6 ± 0.4 ) cm,the mean operation time was ( 41 ± 5 ) min,flatus defecation time was (21.2 ±3.7) h,and the postoperative hospital stay was (6.3 ± 1.2) d in totally laparoscopic group.While that was (2.5 ± 1.2 ) m,( 38 ± 2 ) cm,( 23.6 ± 4.2 ) h,( 6.5 ± 2.3 ) d,respectively in laparoscopicassisted group,and the mean length of incision was (5.0 ± 2.2 ) cm,the mean operation time was (51 ± 6 )min,flatus defecation time was (32.3 ± 6.7) h,the postoperative hospital stay was (8.4 ± 3.8) d in open surgery group.Compared with conventional laparotomy,laparoscopic techniques enjoy advantages of minimal invasion,shorter operative time,fewer complications,shorter recovery period and earlier gastrointestinal recovery(P ＜ 0.05). There were nosignificant differences in operative time, recovery period and complications between totally laparoscopic group and laparoscopic-assisted group.ConclusionsTotally laparoscopic Meckel's diverticulectomy is safe,effective and miniinvasive in experienced hands.

The analysis of variation of Han female adolescent bone development in Henan and Zhejiang province / 法医学杂志

OBJECTIVE@#To study the difference of Han female adolescent bone development in Henan and Zhejiang province.@*METHODS@#All radiography including sternal end of clavicle and six main bone joints were taken from 599 female adolescents with age between 12 to 19 in Henan and Zhejiang province. Twenty four skeletal development indexes were analyzed based on "The Grading Standards" of skeletal growth of teenagers and then the bone age were calculated using mathematical model functions. The ratios of the bone age and the chronological age were analyzed by statistical software.@*RESULTS@#The development of Henan female adolescents' skeleton was about 0.39 years earlier than that in Zhejiang at the age of 14-15 years old. The development of Henan female adolescents' skeleton was about 0.37 years later than that in Zhejiang at the age of 15-16 years old. The development of Henan female adolescents' skeleton was about 0.38 years later than that in Zhejiang at the age of 18-19 years old. There was no statistics significance in other age group.@*CONCLUSION@#The female adolescent bone development in Henan province is faster at earlier stage and then slower than that in Zhejiang province. The results provide potential value for the forensic medicine, anthropology and clinical medicine.