3-phosphoinositide dependent kinase-1 (PDK1) has been shown to be a critical regulator of the PI3K-Akt pathway.PDK1 can activate Akt and participates in the activation of PI3K-Akt signaling pathway to promote tumor development,invasion and metastasis.At present,it has been found that PDK1 is highly expressed in head and neck cancer,multiple myeloma,pancreatic cancer,esophageal cancer,colon cancer and other malignant tumors.Thereby inhibiting PDK1 overexpression may provide a new breakthrough for the treatment of malignant tumor.At present,many kinds of PDK1 inhibitors have been put into production,which plays an important role in tumor therapy.

Objective To analyze the imaging features and follow-up changes of high-resolution CT(HRCT) in Goodpasture syndrome.Methods HRCT imaging features and follow-up findings of 15 cases Goodpasture syndrome confirmed by clinical were analyzed retrospectrively.The imaging features included extent,forms and follow-up changes.Results The lung lesion of Goodpasture syndrome involved two lobes(n=1), three lobes(n=2), four lobes(n=5) and five lobes (n=7).Upper lobe of the right lung was the most common involved region.Centered on the hilum of lung consolidations confused ground glass opacity (GGO) were showed in 7 cases, GGO distribution of pulmonary leaflets in 5 cases.On follow-up observation, lobar or segmental consolidation could change into GGO,GGO could disappear in short times.Conclusion Multiple lobar or segmental consolidations confused GGO without the lung bottom and periphery involvement is the imaging characteristics of Goodpasture syndrome patients with anemia and hemoptysis.HRCT is a helpful method for the diagnosis and following up of Goodpasture syndrome.

Objective To investigate the CT imaging features of pneumonic type Bronchio-loalveolar carcinoma(BAC) and the value of CT-guided percutaneous puncture biopsy in pneumonic type BAC.Methods Twenty-five cases of suspected pneumonic type BAC were biopsied with CT-guided percutaneous puncture.GE 64-slices plain and post contrast CT scans were performed in all patients.Two radiologists finished imaging determination.Site of puncture was selected in suspicious areas of the tumor.The negative pressure aspiration needle were used to be biopsy in the ideal location after vertically into the needle and again performed CT scanning were performed to observe the complications such as hemorrhage,pneumothorax.Specimens were fixed by formalin.Results Twenty-five samples were successfully got from 25 patients.Pathology data showed that 14 cases were pneumonia with BAC,6 cases with pneumonia,2 cases with offungus infection,and 3 cases with caseous pneumonia.Of 14 cases (71.4％) with pneumonia type BAC,CT images of 10 cases showed air bronchogram of lung tissue,5 cases(35.7％) with alveolar gas cavity or cavity of lung tissue,5 cases(35.7％) with ground glass opacity and multiple nodules.Enhanced CT scanning the area of consolidation showed that 11 cases(78.6％) were with mixed low density area angiography and the mean peak time was 90 s,9 cases (64.2％) were with the time density curve of speed up and slow down type.Conclusion The method of CT guided lung biopsy combined with typical imaging findings can enhance early diagnosis rate of pneumonia type BAC.Meanwhile CT feature of pneumonia type BAC shows honeycomb air cavity,void,angiographic sign,dead branches syndrome,multiple peripheral acinar nodules and ground glass density.Enhanced scan area of consolidation shows visible angiogran sign,slow drop type of time density curve of a fast rise.

Objective To evaluate the predictive value of magnetic resonance imaging (MRI)and transvaginal color doppler sonography (TVCDS)for the early-stage cervical cancer.Methods MRI and TVCDS images data of thirty-five patients with early-stage cervical cancer in Kailuan general hospital were retrospectively analyzed.The clinical stage of cases wereⅠb andⅡa.All patients were performed with MRI and TVCDS pre-operation.The accuracy rate of different methods and combined application were statistically analyzed.Results There were significant difference between MRI,TVCDS,MRI combined with TVCDS for tumor diameter,cervical stromal invasion,vaginal invasion,parametrial invasion,lymph node metastases(P<0.05),which accuracy rates were 88.4%,79.2%,89.4%,97.4%, 92.3% respectively for MRI combined with TVCDS.The MRI combined with TVCDS was the best method.Conclusion MRI combined with TVCDS has key value for early diagnosis of cervical cancer pre-operation.It can help to completely understand the situation of early stage cervical cancer and to select the suitable treatment.

Objective To evaluate the correlation of epicardial adipose tissue volume (EATV)with coronary plaques in patients with a coronary artery calcium score of zero.Methods 183 patients with a coronary artery calcium score of zero were selected.They were divided into plaque group and control group according to the findings of CT coronary angiography.Independent t test was used to analyze the difference of EATV between two groups.Results ①EATV was significant higher in plaque group than that in control group (P <0.05).②EATV was non-significant higher in plaque group than that in control group for female individuals (P >0.05), while it was significant higher in plaque group than that in control group for male individuals (P <0.05).③EATV was significant higher in plaque group than that in control group for the individuals with age< 50 years (P <0.05 ),meanwhile it was significant higher in plaque group than that in control group in age≥50 years(P <0.05).Conclusion EATV is correlated with coronary plaques in male patients with a coronary artery calcium score of zero while there is no correlation with female patients.EATV is correlated with coronary plaques in different age patients with a coronary artery calcium score of zero.

Enhanced recovery after surgery (ERAS) has been widely used in the world for near 20 years, which should be considered as the milestone of modern medicine advancement, changing the routine perioperative principle, accelerating the recovery speed following operation, minimizing the postoperative pain, and saving the medical resources. Despite the remarkable advance, the quality and application of ERAS in the west China needs further improvement if compared with international level or even some domestic hospitals. The postoperative hospital stay in west China is much longer than the reported 3 to 5 days according to published references. Several suggestions can be help: (1) Based on the published consensus and the successful experiences of ERAS in colorectal surgery, the medical institution should make great effort to extend this technique to change the profound traditional idea in medical staffs and patients. (2) The medical administrations should take the application of ERAS as a key performance index and annual work plan in hospital. (3) Multiple disciplinary team including anesthetist, surgeon, dietitian, and nurses is essential for hospital to promote the quality of ERAS. Undoubtedly, ERAS is going to be the conventional medical care in the western area of China. We may look forward to seeing more researches from western China to update the ERAS consensus.
China ; Clinical Competence ; Colorectal Surgery ; rehabilitation ; Consensus ; Digestive System Surgical Procedures ; rehabilitation ; Health Knowledge, Attitudes, Practice ; Humans ; Length of Stay ; statistics & numerical data ; Patient Care Team ; standards ; trends ; utilization ; Personnel Administration, Hospital ; methods ; Postoperative Care ; methods ; psychology ; standards ; Postoperative Period ; Quality of Health Care ; standards ; trends

OBJECTIVETo explore the feasibility and safety of transanal minimal invasive or combined laparoscopy total mesorectal excision.

METHODSClinical data of 11 cases with rectal cancer undergoing transanal total mesorectal excision(taTME) in our hospital between September 2014 and May 2015 were analyzed retrospectively.

RESULTSAmong 11 patients, 3 underwent pure-taTME successfully without abdominal incision and ileostomy, whose operation time was 210, 230, 215 min respectively, while other 8 patients underwent laparoscopy-assisted taTME(hybrid-taTME) with operation time ranging from 150 to 290 (median 205) min. No patient was transferred to open operation, while larger tumors of two patients were removed from hypogastric 5 cm incision. Postoperative first day VAS score was 1 to 3(2.0±0.6), the first flatus was 6 to 70(30.2±17.3) h, hospital stay was 4 to 12(7.5±2.5) d, the blood loss was (104±127) ml and the liquid food intake was (28.3±6.3) h. Postoperative complications included 1 case of subcutaneous emphysema, 1 case of anastomotic stoma bleeding, 2 cases of dysuria, which were cured by conservative therapy. One patient developed rectovaginal fistula 20 days after operation and then underwent ileostomy. No relapse of tumor or death during follow-up.

CONCLUSIONSFor suitable rectal cancer patients, taTME or hybrid-taTME is feasible.

Anal Canal ; Humans ; Ileostomy ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Operative Time ; Postoperative Complications ; Rectal Neoplasms ; Retrospective Studies

OBJECTIVETo explore the availability of Da Vinci robotic-assisted transanal total mesorectal excision(taTME) for lower rectal cancer, which have been regarded as challenging situations in rectal cancer surgery.

METHODSThe medical records of a patient who underwent robotic-assisted transanal total mesorectal excision, coloanal anastomosis and ileostomy for lower rectal cancer on May 31st 2017 were reported.

RESULTSThe case was a sixty-three year-old male patient with a body mass index of 19.1 kg/m. Preoperative examinations showed the tumor size was 4 cm×4 cm×3 cm. With a distance from the anal verge of 4 cm.The tumor was moderately differentiated and staged as cT3N2M0.taTME was performed successfully and the patient recovered quickly without any complications. The histological report showed a complete mesorectal excision with freee distal and circumferential margins.

CONCLUSIONRobotic-assisted taTME is available. Robotics may help to overcome technical difficulties.

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OBJECTIVE: To explore the feasibility and safety of Da Vinci robot-assisted transanal total mesorectal excision (taTME). METHODS: From May 2017 to July 2018, six rectal cancer patients underwent Da Vinci robot-assisted taTME at our hospital. The clinical data and short-term follow-up results were retrospectively analyzed. SURGICAL PROCEDURE: The patient was placed in a Trendelenburg lithotomy position and sutured with purse string 1-2 cm from the anus to the distal end of the tumor. A self-made platform for transanal surgery was installed and the robot was connected. The rectum was transected circumferentially 0.5 cm from the distal end of the purse. The robot entered the " holy plane" and separated upward between the visceral parietal fasciae to the level of the third sacrum posteriorly and the peritoneal refcection anteriorly. The abdominal trocar was repositioned and connected to the robot. Through the abdominal cavity, the Toldt space of the posterior sigmoid mesentery was entered, and the D3 lymph nodes were dissected proximally. Separation was performed distally to join the perineal approach. Specimen was pulled out from the anus and excised. The cut end of sigmoid colon was anastomosed with the distal rectum or anal canal. Operative status, postoperative pathology and short-term efficacy were analyzed. Mesorectum of specimen was evaluated as complete, near complete and incomplete according to the Nagtegaal criteria. Anastomotic leakage was evaluated according to the criteria developed by the International Rectal Cancer Research Group. RESULTS: All the 6 patients received Da Vinci robot-assisted taTME and sigmoid-anal anastomosis. In the 6 patients, 3 were male and 3 female; mean age was (62.6±2.6) years old; body mass index was (20.5±3.0) kg/m; distance from tumor to anal edge was (39.4±12.0) mm; length of tumor was (33.6±9.2) mm. Four patients received neoadjuvant therapy before surgery. All the patients completed operations successfully without conversion to laparotomy perioperative, severe complications or death. The mean total operative time was (245.8±24.2) minutes; transition interval of two procedures was (21.2±2.6) minutes; time of transanal robotic dissection of mesorectum was (72.3±15.2) minutes; intra-operative blood loss was (86.7±59.9) ml; the height of anastomosis was (16.0±6.1) mm. There were no intra-operative complications including accidental hemorrhage or urethral injury in any patients. The length of the specimens was (177.0±33.3) mm, and the mesorectum was complete in 5 cases, and near complete in 1 case. The mean distal margin was (20.2±3.2) mm, and the proximal, distal and circumferential margins were all negative. Postoperative pathological staging: T0N0 in 1 case, T0N1 in 1 case , T2N0 in 2 cases , T4N1 in 1 case, T3N0 in 1 case. The former 5 cases received clear fluit diet on the first day, and received fluid diet on the second day after operation. The drainage tube was removed 3 to 6 days after operation. The postoperative hospital stay was 5 to 7 days. The sixth case developed grade B anastomotic leakage on the third day after operation and healed by conservative treatment. No postoperative death, and no serious complications such as intra-abdominal hemorrhage, intestinal obstruction were found. All the patients were followed up for 5 to 19 months, and no local recurrence and death were observed. CONCLUSION The robotic system is safe and feasible for taTME procedure in rectal cancer with good short-term efficacy. However, the long-term outcomes require further observation.
Aged ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; Rectum ; Retrospective Studies ; Robotic Surgical Procedures