Development and Verification of a Traditional Chinese Medicine Diagnostic Scale for Type 2 Diabetes Mellitus with Turbid-Toxin Accumulation Syndrome / 中医杂志

To develop a traditional Chinese medicine （TCM） diagnostic scale for type 2 diabetes mellitus with turbid-toxin accumulation syndrome and to validate the performance of the scale. A candidate pool was established through literature review and expert consultation， and a clinical case information collection form was developed accordingly. Patients with type 2 diabetes mellitus admitted to the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from July 2021 to January 2022 were investigated， and 312 valid clinical case information collection forms were obtained， which were randomly divided into 235 cases in the study group and 77 cases in the validation group. Four statistical methods， namely， differentiation analysis， Cronbach's coefficient， correlation coefficient， and stepwise regression， were used to screen out the candidate items， and Logistic regression analysis and factor analysis were used to assign weights to the items， and the final diagnostic model was determined by the receiver operating characteristic （ROC） curve， and the diagnostic thresholds were calculated for the Yoden index. The final TCM diagnostic scale for type 2 diabetes mellitus was composed of 8 items： turbid dirt coating （with a weight value of 23， the same below）， sticky stools （16）， fullness in the epigastrium and abdomen （12）， dark complexion （12）， irritability （11）， brown spots on the skin （11）， heaviness of head （10）， and chest stuffiness （5）， and the degree score was 0， 0.5， 1.0， and 1.5 points corresponding to no， mild， moderate and severe symptoms， respectively. The total score was the sum of the degree score multiplied by the weighted value of each item， and when the total score reached 33 points， it is diagnosed as the turbid-toxin accumulation syndrome. The established scale was tested and evaluated in the study group and the validation group， and the results showed that the sensitivity of the study group and the validation group was 89.38% and 89.47%， with the specificity of 95.90% and 89.74%， the Yoden index of 0.85 and 0.79， the positive predictive value of 95.28% and 89.47%， the negative predictive value of 90.70% and 89.74%， the diagnostic advantage ratios of 198.18 and 72.67， and the Kappa values of 0.86 and 0.79， which indicated that the TCM diagnostic scale for turbid-toxin accumulation syndrome of type 2 diabetes mellitus showed good diagnostic ability.

The experience on trocar layout method for robotic "3+2" mode gastrointestinal surgery / 中华普通外科杂志

Objective:Based on experience of robotic gastrointestinal surgery at the Department of General Surgery, Clinical Medicine Center of Gansu Provincial Hospital, this study explored the principles and methods of trocar layout for robotic "3+2" mode gastrointestinal surgery, suitable for beginners.Methods:From Apr 2017 to Oct 2022, the robotic gastrointestinal surgery team of Gansu Provincial Hospital completed 998 cases of robotic "3+2" mode gastrointestinal surgery, including 600 cases of gastric cancer, 100 cases of rectal cancer, 98 cases of descending colon and sigmoid colon cancer, 20 cases of transverse colon cancer, and 180 cases of right colon cancer. Through the continuous optimization and improvement of the problems encountered during the operation, combined with the operator's experience, and taking into account various aspects, we developed the robotic "3+2" mode trocar layout for gastrointestinal surgery.Results:Four principles of trocar layout were developed, namely, the principle of lens placement around the navel, the principle of symmetry in the main operation, the principle of 8-10cm distance between trocar holes, and the principle of symmetry in the auxiliary hole lens. Three trocar layout methods and principles applicable to robotic gastric surgery, and four applicable to robotic colorectal surgery were developed.Conclusion:The trocar layout method of robotic "3+2" mode gastrointestinal surgery is established based on a large number of robotic gastrointestinal surgery experiences. This method is simple and easy to learn, with strong repeatability and operability.

Research Progress of PD-L1 Expression in Circulating Tumor Cells in Malignant Tumors / 肿瘤防治研究

In recent years, with the in-depth study of PD-1 and PD-L1 and the development of immunotherapy, the first problem is how to screen the beneficiaries. Recent clinical studies have shown that the expression level of PD-L1 in circulating tumor cells (CTC) can be used as a potential biomarker to play a guiding role in immunotherapy of malignant tumors. This article reviews the latest clinical research progress on the expression of PD-L1 in circulating tumor cells in various solid tumors.

The safety and effectiveness of the Da Vinci robot "3+ 2" mode in radical gastrectomy / 中华普通外科杂志

Objective@#To explore the safety, feasibility and advantages of Da Vinci robot "3+ 2" mode in radical gastrectomy.@*Methods@#Clinical data of 30 patients received radical gastrectomy at our department under the "3+ 2" mode of Da Vinci robot from Jan. 2018 to Oct. 2018 were retrospectively analyzed. 30 patients who received classical robot mode in the same period were randomly selected as control group.@*Results@#Compared with the control group, the observation group had a shorter operative time (174±16)min vs.(197±19)min, t=-3.275, P<0.01) , a lower operation costs[(22 794±3 660)yuan vs.(29 307±3 220)yuan, t=-3.316, P<0.01; and inhospital costs (70 910±6 399)yuan vs.(78 180±6 636)yuan), t=-7.316, P<0.01].@*Conclusion@#The "3+ 2" mode of Da Vinci robot in radical gastrectomy is beneficial to enhance the exposure of the surgical field, improve the cooperation of assistants, reduce the costs of surgery, shorten the operative time and the learning curves. In addition, it has similar clinical efficacy to radical gastrectomy under the classical robot mode.

The safety and effectiveness of the Da Vinci robot "3 +2" mode in radical gastrectomy / 中华普通外科杂志

Objective To explore the safety,feasibility and advantages of Da Vinci robot "3 + 2" mode in radical gastrectomy.Methods Clinical data of 30 patients received radical gastrectomy at our department under the "3 + 2" mode of Da Vinci robot from Jan.2018 to Oct.2018 were retrospectively analyzed.30 patients who received classical robot mode in the same period were randomly selected as control group.Results Compared with the control group,the observation group had a shorter operative time (174 ± 16) min vs.(197 ± 19) min,t =-3.275,P ＜ 0.01),a lower operation costs [(22 794 ± 3 660)yuan vs.(29 307 ±3 220)yuan,t =-3.316,P ＜0.01;and inhospital costs (70 910 ±6 399) yuan vs.(78 180 ±6 636)yuan),t =-7.316,P ＜0.01].Conclusion The "3 +2" mode of Da Vinci robot in radical gastrectomy is beneficial to enhance the exposure of the surgical field,improve the cooperation of assistants,reduce the costs of surgery,shorten the operative time and the learning curves.In addition,it has similar clinical efficacy to radical gastrectomy under the classical robot mode.

Effect of polyunsaturated fatty acids ω-3 and ω-6 on angiogenesis formation in human gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of polyunsaturated fatty acids (PUFA) ω-3 and ω-6, and their middle metabolites PGE2 and PGE3 on angiogenesis formation of gastric cancer, and to explore associated mechanism.</p><p><b>METHODS</b>The effects of ω-3, ω-6, PGE2, PGE3 on the proliferation and migration of human umbilical vein endothelial cell (HUVEC) were measured by proliferation and migration assay respectively. The angiogenesis assay in vivo was used to measure the effects of ω-3, ω-6, PGE2 and PGE3 on neovascularization. In all the assays, groups without ω-3, ω-6, PGE2 and PGE3 were designed as the control.</p><p><b>RESULTS</b>With the increased concentration of ω-6 from 1 μmol/L to 10 μmol/L, the proliferation ability of HUVECs enhanced, and the number of migration cells also increased from 28.2±3.0 to 32.8±2.1, which was higher than control group (21.2±3.2) respectively (both P<0.05). With the increased concentration of ω-3 from 1 μmol/L to 10 μmol/L, the proliferation ability of HUVECs was inhibited, and the number of migration cells decreased from 15.8±2.0 to 11.0±2.1, which was lower than control group (22.1±3.0) respectively (both P<0.05). In the angiogenesis assay, compared with control group (standard number: 43 721±4 654), the angiogenesis ability of HUVECs was significantly enhanced by ω-6 in concentration-dependent manner (1 μmol/L group: 63 238±4 795, 10 μmol/L group: 78 166±6 123, all P<0.01). Meanwhile, with the increased concentration of ω-3 from 1 μmol/L to 10 μmol/L, the angiogenesis ability was significantly decreased from 30 129±3 102 to 20 012±1 541(all P<0.01). The proliferation and migration ability of HUVECs were significantly promoted by ω-6 metabolites PGE2 (P<0.05) in a concentration-dependent manner. In contrast, ω-3 metabolites PGE3 significantly inhibited the proliferation and migration ability of HUVECs in a concentration-dependent manner (all P<0.05). After rofecoxib (a COX-2 specific inhibitor) inhibited the expression of COX-2, the expression level of PGE2 was significantly decreased in a dose-dependent manner. In co-culture system, whose gastric cancer cells expressed positive COX-2, ω-6 could increase angiogenesis of gastric cancer cells(P<0.01), but ω-3 could inhibit such angiogenesis(P<0.01). In co-culture system, whose gastric cancer cells did not express COX-2, ω-3 could inhibit the angiogenesis of gastric cancer cells (P<0.05), but ω-6 had no effect on angiogenesis.</p><p><b>CONCLUSIONS</b>The PUFA ω-6 can enhance the angiogenesis via the promotion of proliferation and migration of HUVECs, and COX-2 and PGE2 may play an important role in this process, whereas, the ω-3 can inhibit the angiogenesis through its middle metabolites PGE3 to inhibit the proliferation and migration of HUVECs. Results of this experiment may provide a new approach to inhibit and prevent the spread of gastric cancer.</p>

Application of Laparoscopy to Acute Abdominal Pain / 中国微创外科杂志

Objective To explore the efficacy of laparoscopy in acute abdominal pain. Methods From March 2002 to March 2007,306 patients with acute abdominal pain were explored and treated by laparoscopy in our hospital. The patients were diagnosed with acute appendicitis in 105 cases,unidentified abdominal pain in 34,acute cholecystitis complicated with cholecystolithiasis in 64,gastrointestinal tract perforation in 51,common bile duct stones complicated with acute cholangitis in 5,intestinal obstruction in 33,and severe acute pancreatitis in 5; 9 patients were confirmed as having trauma. Results All the 306 patients were unequivocally diagnosed during the operation. Laparoscopy was successfully completed in 275 cases,including 123 cases of appendectomy,57 cases of cholecystectomy,48 cases of gastrointestinal tract perforation neoplasty,13 cases of enterodialysis,4 cases of intestinal replacement combined with indirect hernia repair,4 cases of radical resection of the sigmoid colon with precolon anastomosis,1 case of small-incision segmental resection of the small bowel,3 cases of common bile duct resection and calculus removal,2 cases of neoplasty for right-lobe hepatorrhexis,3 cases of haemostasis for splenic rupture,5 cases of debridement and clysis and drainage for severe acute pancreatitis ,and 12 cases of laparoscopic abdominal exploration (2 cases of mesentery contusion and laceration,1 case of abdominal wall punctured wound with contusion of the greater omentum,8 case of primary peritonitis,and 1 case of abdomen-type allergic purpura). The remaining 31 patients were converted to open surgery because of difficulties in laparoscopy. The patients were followed up for 1 to 18 months,during which no one showed intra-or post-operative complications.Conclusions Emergency laparoscopic exploration can not only clarify a diagnosis for acute abdominal pain with unknown causes,but also treat the cases simultaneously. Moreover,it is of great help in guiding abdominal resection and making a suitable operative incision,even if the patients can not be treated by laparoscopy alone.

Clinical Analysis of Combined Laparoscopic Surgery: A Report of 728 cases / 中国微创外科杂志

Objective To explore advantages of combined laparoscopic surgery(CLS).Methods The clinical data of 728 cases of CLS from July 1992 to March 2006 were analyzed retrospectively,including 586 cases of laparoscopic cholecystectomy(LC) combined with fenestration drainage of hepatic cysts,80 cases of LC combined with appendectomy,46 cases of LC combined with oophorocystectomy,16 cases of LC combined with unroofing and drainage of renal cysts.Results 726 cases of CLS were successfully performed,and 2 cases were converted to open surgery for abdominal adherence,with no complications such as bile duct injury,hemorrhea,infection and death occurred.During a mean follow-up period of 16 months(range,2-60 months) in 512 cases,no biliary calculi,recurrence of liver,kidney and ovarian cysts occurred.Conclusions CLS for two kinds or more abdominal diseases in one operation is safe and effective,with advantages of minimal invasion,less pain,and quicker recovery and so on.

Laparoscopic repair of acute gastric perforation / 中国普通外科杂志

Objective To summarize the effect of laparoscopic repair of acute gastric perforation. Methods Patients with acute gastric perforation underwent laparoscopic repair and abdominal drainage under intravenous- inhalation general anesthesia after a histological biopsy. Results Forty-six patients with acute gastric perforation were successfully operated.Of which, 6 patients with pylonic perforation, 37 patients with perforation in the front wall of gastric antrum, 3 patients with perforation in stomach body. Thirty-three cases were received frozen section biopsy, only 1 case showed a cancer in the lesser curve of stomach body. There was no complications occurred and no operative mortality in this series. Of the 45 benign ulcers patients,31 patients were discharged 7 days after the operation, 14 patients were discharged 2 weeks after medication treatment.Three months after operation the symptoms of the 45 patients disappeared totally,they had normal diet,and got body weight 1-3kg. Pathological examination showed that no malignant cell was found in 45 benign ulcer patients. The cancer patient was discharged 9 days after operation and refusing to further treatment. Conclusions Laparoscopic repair is a safe mini-invasive method, and it isn′t breach the surgical principles,it allows the patients recover quickly and with less complications. The intraoperative biopsy can prevent misdiagnosis of cancer. It is an effective treatment for acute gastric perforation and worthy to be widely used.

Relationship between Occupational Lead Exposure and Spontaneous Abortion / 环境与健康杂志

Objective To analyze and evaluate the relationship between occupational lead exposure and spontaneous abortion.Methods The papers on the relationship of occupational exposure to lead and spontaneous abortion of female workers published in Chinese in 1991-2007 were searched by using computer and manual search,after strict selection,the homogeneity test and integrated analysis for the abstracted data of the eligible studies were conducted by using Rev.Man Statistic Software.The combined RR value was used as the total effect target of each project of meta-analysis.Results In total,14 original researches were included(totally 4 330 subjects and 11 970 controls),compared with the control,the occupational exposure to lead was significantly associated with spontaneous abortion(RR=2.83,95% CI:1.97-4.07)(P