Objective:To study the effect of supplementation of calcium and sunshine during pregnancy on serum level of total 25-hydroxyvitamin vitamin D (25-OH-D) . Methods: A total of 151 cases of normal pregnant women were divided into four groups:without calcium and sunshine, without calcium and with sunshine, with calcium and without sunshine, with calcium and sunshine. LIAISON XL chemiluminescence analyzer was used to detect the serum level of 25-OH-D. Results:Compared with the group of without calcium and sunshine, the serum level of 25-OH-D in other groups increased significantly.The calcium deficiency rate of puerpera and neonatal decreased significantly.The reference range was 13.96 ng/ml (2.5%percentile), 39.54 ng/ml (50%percentile) and 73.90 ng/ml (92.5%percentile) .The mean value of 25-OH-D was (41.67 ± 14.72) ng/ml.Conclusion:Proper supplementation of calcium and adequate sunshine during pregnancy can prevent calcium deficiency of puerpera and neonate.The reference range of serum 25-OH-D is slightly lower than that in general population.

Objective:To investigate the characteristics, causes and preventive strategies of intraoperative and postoperative complications of Da Vince robotic radical resection for lung cancer.Methods:From January 2018 to June 2020, 306 patients with lung cancer who underwent robotic radical resection of lung cancer in our department were reviewed, the perioperative data were statistically analyzed. There were 154 males and 152 females, aged(58.5±10.3) years old, 238 lobectomy cases and 68 segmental lobectomy cases.Results:There were no perioperative death, no conversion to thoracotomy, and no intraoperative vascular injury. Intraoperative blood loss was(41.5±37.4)ml, 302 cases(98.7%) underwent R0 resection, 54 cases(17.6%) of intraoperative bleeding from troca mouth of robot operating arm. 32 cases(10.5%) of postoperative complications, including 3 cases(1.0%) of chylothorax, 1 case(0.3%) of pleural effusion, 28 cases( 9.2%) of alveolar fistula over 7 days with 5 cases of large area subcutaneous emphysema.Conclusion:The most common intraoperative complication in robotic lung cancer radical operation is troca bleeding, and the most common postoperative complication is alveolar fistula. Robot surgery is safe, and targeted preventive measures can reduce the incidence of complications.

OBJECTIVE：To prov ide effective improvement paths and policy suggestions for improving the innovation efficiency of TCM industrial enterprises. METHODS ：Based on the input and output data of innovation resources of 38 listed TCM industrial enterprises from 2014 to 2020，an evaluation index system was constructed from the perspective of all factors. First ，the deta envelopment analysis （DEA）model was used to measure the static efficiency of the sample enterprises ，and at the same time ， four patterns of innovative resource utilization were provided ；then the total factor Malmquist index method was used to analyze the decomposition of the changes in utilization efficiency of innovative resources according to different periods and micro-individuals. RESULTS & CONCLUSIONS ：The overall efficiency of innovative resource utilization of listed TCM industrial enterprises was too low，and the average overall efficiency was only 0.293. The input and output of innovation resources of 33 enterprises were unreasonable，and the reasons for the inefficiency are mostly due to insufficient pure technical efficiency. The average value of the all-factor Malmquist index was 0.818 for 38 sample enterprises ，and the overall efficiency was declining. The obstacles to technological progress were a more important reason for the decline in efficiency. It is recommended to improve TCM industrial enterprise’s ability to allocate innovation resources and adjust the proportion of R&D investment in conjunction with the return to scale；clarify the development principles with scientific and technological innovation as the core driving force ，and actively carry out basic research work ；implement the production and research platform of “TCM industrial enterprise-TCM research institution ” to promote the overall technological progress of the industry.

Objective    To explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management. Methods    From January to December 2018, our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients, including the upper right lung lobe in 2 patients, the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients. There were 3 males and 2 females with an age of 56.6 (39-75) years. The surgical approach was the same as the surgical incision of the robotic lobectomy. During the operation, the lobes were separated, all enlarged mediastinal lymph nodes were cleaned, pulmonary hilum was dissected, pulmonary arteriovenous vessels and bronchi were exposed, and pulmonary vessels were treated. After exposing the main bronchi, the bronchi were cut off at the distal end of the lesion, and the lobes where the lesion was located (including lesions) were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis. After the anastomosis, no air leakage was found in the expanded lung, and the anastomosis was no longer wrapped. Results    The operation time was 147.4 (100-192) min, including bronchial anastomosis time 17.6 (14-25) min. Intraoperative blood loss was 60.0 (20-100) mL, and 20 (9-37) lymph nodes were dissected. Three patients had squamous cell carcinoma, 1 adenocarcinoma, and 1 neuroendocrine tumor. All patients showed negative results in the freezing pathology of bronchial stump during operation. All patients recovered well after surgery, without perioperative complications, and the anastomosis was smooth. Postoperative hospital stay was 10.8 (7-14) days. The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications. Conclusion    Since the robot system is a special instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is more flexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.

Objective    To explore the factors that affect the drainage time of da Vinci robot lung cancer surgery, to analyze the coping strategies, and to provide a basis for shortening the drainage time of patients after surgery and speeding up the patients' recovery. Methods    The clinical data of 131 patients who underwent da Vinci robot lung cancer surgery at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from January 2019 to October 2019 were retrospectively analyzed. Among them, 68 were males and 63 were females, with an average age of 59.84±9.66 years. According to the postoperative thoracic drainage time, the patients were divided into two groups including a group A (drainage time≤ 5 days) and a group B (drainage time >5 days). Univariate analysis and logistic multivariate regression analysis were used to analyze the factors that may affect postoperative drainage time, and the correlation between different influencing factors and thoracic drainage time after da Vinci robot lung cancer surgery. Results    Logistic multivariate analysis showed that age≥60 years (P=0.014), diabetes mellitus (P=0.035), operation time≥130 min (P=0.018), number of lymph node dissections≥15 (P=0.002), and preoperative albumin<38.45 g/L (P=0.010) were independent factors affecting the drainage time of da Vinci robot lung cancer surgery. Conclusion    For elderly patients with diabetes mellitus during the perioperative period, blood glucose should be actively controlled, reasonable surgical strategies should be formulated to ensure the safety and effectiveness of the operation, while reducing intraoperative damage and shortening the operation time. After the operation, patients should be guided to strengthen active coughing, expectoration and lung expansion. Thereby it can shorten drainage time and speed up the recovery of patients after operation.

Objective     To compare the effects of anterior mediastinal tumor resection by the Da Vinci robot and video-assisted thoracoscopy via subxiphoid approach. Methods     A retrospective cohort study was conducted to continuously enroll patients who underwent anterior mediastinal tumor resection between 2020 and 2021 in our department. They were divided into a robotic group and a subxiphoid thoracoscopic group. The differences of general indexes (intraoperative blood loss, postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative pain visual analogue scale (VAS), perioperative declining levels of hemoglobin, hematocrit, serum prealbumin and serum albumin were compared and analyzed. Results     A total of 113 patients were enrolled. There were 76 patients in the robotic group (46 males and 30 females, median age of 50 years) and 37 patients in the subxiphoid thoracoscopic group (21 males and 16 females, median age of 51 years). Intraoperative blood loss, postoperative drainage volume, postoperative catheterization time and postoperative hospital stay of the robotic group were better than those in the subxiphoid thoracoscopic group (P<0.05). The postoperative VAS scores in the robotic group were lower than those in the subxiphoid thoracoscopic group, but there was no statistical difference (P>0.05). Perioperative declining levels of hemoglobin, and hematocrit were not statistically different between the two groups (P>0.05). Declining levels of serum prealbumin, and serum albumin in the robotic group were lower than those in the subxiphoid thoracoscopic group (P<0.05). Conclusion     Da Vinci robotic and subxiphoid video-assisted thoracoscopic surgeries for the treatment of anterior mediastinal tumors are both safe and reliable, with short postoperative hospital stay, mild postoperative pain and quick recovery. Da Vinci robot surgery has a slight advantage in the treatment outcome.

Objective    To compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma. Methods    From January 2012 to December 2018, 291  patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes. Results     Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS. Conclusion    There is no statistical difference in OS between the two groups, but the RATS group gets better DFS.

Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. Methods Retrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January 2010 and December 2017 in our hospital. There were 29 males and 24 females, aged 17-73 years. Patients were divided into three groups according to the surgical methods: a group A (video-assisted thoracoscopic surgery with the da Vinci robotic system, n=22), a group B (video-assisted thoracoscopic surgery, n=12) and a group C (median sternotomy, n=19). The gender distribution, age, intraoperative blood loss, operation time, postoperative extubation time, postoperative hospital stay, Osserman classification of myasthenia gravis, postoperative myasthenic remission rate, etc were compared in three groups. Results No perioperative death was observed in 53 patients. One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment. One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the intraoperative injury of the left brachiocephalic vein. Compared with the group B and group C, the group A had shorter operation time, less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation. Postoperative hospital stay was less in the group A than that in the group C (P<0.05). The postoperative myasthenic remission rate was higher in the group A than that in the other two groups, but there was no statistical difference. Conclusion Because of the robot’s unique minimally invasive advantage, in this study, the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate. But long-term results and a large of number matching experiments are needed to confirm. However, it is undeniable that robotic surgery must be the future of the minimally invasive surgery.

Objective To analyze the feasibility of totally no tube (TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery (VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay, postoperative hospital stay, postoperative visual analogue scale (VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications (postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay (P<0.01); there was no significant difference in the total cost of hospitalization between the two groups (P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay (P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss, VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay (P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher (P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.

BACKGROUND: Da Vinci robotic surgery system is widely used in department of thoracic surgery. The aim of this study is to investigate the treatment outcome of stage I non-small cell lung cancer (NSCLC) via da Vinci Surgical System. METHODS: Clinical date of 347 stage I NSCLC patients, who underwent lobectomy and systematic node dissection from Jan. 2012 to Dec. 2017, were reviewed. 134 patients underwent robot-assisted thoracic surgery (RATS) and 213 patients underwent video-assisted thoracic surgery (VATS). To compare perioperative outcome (blood lose, postoperative drainage, drainage time, postoperative hospital stay, number of the LN dissection) and analyze overall survival (OS), disease free survival (DFS) of the two groups and prognostic factors. RESULTS: The RATS group got less blood lose [(49±39 mL for RATS vs (202±239) mL for VATS, P<0.05] and postoperative drainage [Day 1: (248±123) mL for RATS vs (350±213) mL for VATS; Day 2: (288±189) mL for RATS vs (338±189) mL for VATS, P<0.05]. There were no significant difference for drainage time (10±5 for RATS vs 11±8 for VATS, P<0.05) and postoperative hospital stay (13±6 for RATS vs 14±9 for VATS, P<0.05) between the two groups. The RATS group harvested a more number of mean stations (5±2 for RATS vs 4±2 for VATS) and amounts (18±9 for RATS vs 11±8 for VATS) of the lymph nodes, P<0.05. There was no statistically significant difference of OS between RATS and VATS group [1-year OS: 97.3% vs 96%; 3-year OS: 89.8% vs 83.1%; 5-year OS: 87.5 % vs 70.3%; overall survival time (mean): 61 months vs 59 months, P>0.05]; corresponding there had a statistically significant difference of DFS between the two groups [1-year DFS: 93.7% vs 91.3%; 3-year DFS: 87.7% vs 68.4%; 5-year DFS: 87.7% vs 52.5%; disease free survival time (mean): 61 months vs 50 months, P<0.05]. The univariate analysis found that the amounts of the lymph nodes dissection was the prognostic factor for OS and tumor diameter, surgical approach, stations and amounts of the lymph nodes dissection were respectively the prognostic factors for DFS. However, multivariate analysis found that there was not independently factors for OS, but the tumor diameter and surgical approach were independently associated with DFS. CONCLUSIONS There was no significant difference about OS between the two groups, but the RATS got better DFS. RATS got more number of the LN dissection and less blood lose.
Adult ; Carcinoma, Non-Small-Cell Lung ; pathology ; surgery ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms ; pathology ; surgery ; Male ; Neoplasm Staging ; Retrospective Studies ; Robotics ; Thoracic Surgery, Video-Assisted