Patient positioning, port placements setting and robot cart docking in pediatric robot-assisted laparoscopic upper urinary tract operation / 中华泌尿外科杂志

Objective To summarize the experience of patient positing,port placements setting and robot cart docking in pediatric robot-assisted laparoscopic upper urinary tract operations.Methods From March 2017 to December 2017,140 robot-assisted laparoscopic upper urinary tract procedures were performed in our institution,including 110 cases of pyeloplasty,15 upper pole heminephroureterectomy,12 simple nephrectomy and 3 adrenalectomy.There were 103 males and 37 females with a range age from 1 month to 18 years.The assistant surgeon was adjacent to the instrument nurse,and patients were placed in a supine position with 60°-80° inclination and keep the legs low to the body.Room setup and patient positioning were similar to the traditional laparoscopic surgery.Semi-hidden incision technique was used in 140 patients:the camera port was placed umbilicus,two additional arm ports (one 5 mm and one 8 mm) were placed under direct vision,the 8 mm arm port was placed on the line of a Pfannenstiel incision and the 5 mm arm port was placed below the Xiphoid along the midline.Finally,a 3 or 5 mm assistant port was placed approximately 3 cm lateral to the inferior arm port,the line of a Pfannenstiel incision.Results The average time was (11.5 ± 3.2) min (10.5-16.5 min) from skin incision to robot cart docking completed.All surgeries were successfully completed without open conversion.One patient required an additional assist port for severe adhesion after the previously open surgery,there was no injury to other viscera.Average operative time was (146.9 ± 48.7)min (78-259 min) and average post-operative hospitalization time was (5.7 ± 1.4) d(4-10 d),respectively.There was no visual scar on abdominal 6 weeks postoperatively,and all parents made comments about their satisfaction with the cosmetic appearance.All operations got complete success at a mean follow up of 6 (1-9) months.Conclusions A good room setup,patient positioning and the semi-hidden incision technique port placements are maintaining the safety of the patient,avoiding compression injuries,allowing maximum mobility of the robotic arms,and facilitating a smooth and efficient surgery,and improving post-operative recovery.

Serum differential proteomic analysis of endometriosis and adenomyosis by iTRAQ technique.

OBJECTIVE(S): Adenomyosis and endometriosis are two different diseases, although they have similar pathogenesis and characteristic. The serum differential expressed proteins in adenomyosis and endometriosis may result from the different pathogenesis of two diseases. Proteomic technology is a useful method for detecting all the proteins in samples. We try to use isobaric tags for relative and absolute quantitation (iTRAQ) technology to explore the association between the potential pathogenesis of these two diseases and these identified proteins. STUDY DESIGN: The serum samples from 20 patients with adenomyosis and from 20 patients with endometriosis were analyzed using iTRAQ technology to detect the differential expression of proteins. The validation of the proteins was performed using Western blot. RESULTS: In the serum of women with adenomyosis and with endometriosis, 14 proteins were found differentially expressed using iTRAQ technology. Nine proteins were high-expression in adenomyosis group and four proteins increased in endometriosis group. And the differential expression proteins were validated by Western blot. CONCLUSION(S): The proteins increased in adenomyosis group are related to blood coagulation and complement activation effects, and the proteins high-expression in endometriosis mainly take part in the process of inflammatory response and regulation of apoptosis. The differentially expressed proteins in two groups may due to the different pathogenesis of two diseases.

Comparative serum proteomic analysis of adenomyosis using the isobaric tags for relative and absolute quantitation technique.

OBJECTIVE: To identify differentially expressed proteins from the serum of women with and without adenomyosis and to explore the potential pathogenesis of adenomyosis. DESIGN: Serum samples from patients with adenomyosis were compared with samples from healthy controls. SETTING: University hospital. PATIENT(S): Twenty patients with adenomyosis and 20 healthy volunteers. INTERVENTION(S): Collection of serum samples. MAIN OUTCOME MEASURE(S): Protein expression of serum was evaluated with iTRAQ (isobaric tags for relative and absolute quantitation) technology, and the validation of protein was performed with Western blot. RESULT(S): A total of 167 proteins were identified from 1,406 distinct peptides using iTRAQ technology. Twenty-five proteins were abnormally expressed in adenomyosis patients compared with the control group; 4 of these proteins were significantly down-regulated and 21 were significantly up-regulated in women with adenomyosis. Western blotting was used to validate the relative increases in serum protein levels for three of the identified proteins. CONCLUSION(S): The differentially expressed proteins identified in our study are mainly involved in cell adhesion, the immune response, and the inflammatory response. On the basis of the results of this study, it can be concluded that these mechanisms may play an important role in the pathogenesis of adenomyosis. Additionally, these proteins may provide clues for not only a promising biomarker for the diagnosis of adenomyosis but also a potential target for therapeutic intervention.

How to improve the quality of clinical practice of obstetrics and gynecology in new era / 中华医学教育探索杂志

In order to culture the qualified clinicians, we should think about how to improve the quality of clinical practice of obstetrics and gynecology. It is of great importance to emphasize the teachers and students to value the teaching work together. Importance should be attached to the advantage of subject of academy, to make the clinical practice closer to practical, which has a perfect effect and will benefit our work.

Clinical characteristics and outcomes of cerebral venous sinus thrombosis during pregnancy and puerperium / 中华妇产科杂志

Objective To explore the clinical features and outcomes of patients with cerebral venous sinus thrombosis (CVT) during pregnancy and puerperium.Methods A retrospective study was performed in 24 cases of pregnant women with CVT among 15 625 deliveries in Xuanwu Hospital fromJanuary 2002 to October 2009,including 7 cases happened during pregnancy and 17 during puerperium.The etiology,clinical presentations,imaging examination results,other relevant examinations,and pregnant outcomes of these patients were analyzed.Results (1) Incidence and etiology:the incidence of CVT during pregnancy and puerperium was 0.15% (24/15 652) and 29% (7/24) of the patients fell ill during pregnancy and 71% (17/24) during puerperium.Five were complicated with severe preeclampsia,while another 5 complicated with hyperemesis.One woman was complicated with anemia.CVT was identified after spontaneous delivery in 9 cases and 8 after cesarean section.(2) Clinical presentations:Among the 24 CVT cases,22(92% ) suffered from headache,16(67% ) reported nausea and vomiting,15(63% )experienced hyperspasmia and 6 (25%) complained of blurred vision.On admission,8 (33%) patients were unconscious,3 (13%) with hemiplegia,and 8 (33%) were febrile.(3) Imaging and laboratory examinations:twelve patients underwent digital subtraction arteriography ( DSA) and were diagnosed.Fifteen women showed superior sagittal sinus thrombosis in MRI and magnetic resonance intravenous angiograph(MRV).Examination of the fundus found papilledema in 4 cases.Normal cerebral sinus fluid and laboratory routine tests were reported in 13 cases,but 6 cases of hyperlipidemia,7 cases of abnormal activated partial thromboplastin time ( APTT),5 cases of abnormal international normalized ratio (INR),3 cases elevated platelet count,4 cases of positive D-dipolymer,1 cases of low hemoglobulin level ( <10 g/L),4 cases with abnormal hematocrit,and 10 cases of elevated fibrinogen ( > 4 g/L) were identified.(4) Management and pregnancy outcomes; among the 7 cases happened during pregnancy,2 were complicated with severe preeclampsia and delivered through cesarean section immediately and discharged after proper management including depressurization,spasmolysis,dehydration and anticoagulant therapy.Five of the 7 cases presented with CVT during early pregnancy,among which 1 was discharged after dilation and curettage followed by anticoagulant therapy,2 received endovascular thrombolysis after which one was discharged and the other one left with right hemiparesis and 2 patients died.Among the 17 patients presented with CVT during puerperium,10 received anticoagulant therapy after which 4 were fully recovered,5 left with functional disturbance (3 with hemiplegia,1 with incomplete motor aphasia and hemiparesis and 1 with blurred vision) and one died.Among the rest 7 cases who underwent endovascular thrombolysis,3 were fully recovered,3 left with functional impairment ( 1 with blind and headache and 2 with hemiplegia),and one died.Altogether,there were 14 patients underwent systemic anticoagulant therapy after which 7 were fully recovered,5 left with dysfunction and 2 died.Among the 10 cases received endovascular thrombolysis,4 were fully recovered,4 remained some dysfunction and 2 died.Conclusions CVT,mostly presented as superior sagittal sinus thrombosis,are more common in puerperium than during pregnancy and DSA is the golden standard for the diagnosis of CVT.Anticoagulant therapy and endovascular thrombolysis are effective in the treatment of CVT,but may left the patients with functional disturbance or even death.Prompt diagnosis and treatment ensure a better outcome for pregnant women complicated with CVT.