Laparoscopic surgery for upper-third gastric cancer has gradually been accepted by experienced surgeons as the mature of this technique.Different from the standardized and programmed D2 lymph node dissection in Laparoscopy-assisted Billroth Ⅰ gastrectomy,the indications and methods for laparoscopic splenic hilar lymphadectomy in the upper-third gastric cancer remains controversial.Unsolved problems include joint organs resection,appropriate surgical approach selection and variable vascular anatomy of the splenic hilum.Meanwhile,the long-term efficacy and safety of laparoscopic splenic hilar lymphadectomy for the upper-third gastric surgery need to be confirmed by evidence-based medical trials.With the advance of the theory and clinical practice,laparoscopic splenic hilar lymph node dissection will continue to progress.

Objective To develop a protocol for ultrasound-guided percutaneous radiofrequency ablation (RFA) on hepatic tumors larger than 3.5 cm in diameter, and to evaluate its role in ablation treatment. Methods Mathematical analysis was performed to generate the preoperative protocol which included the least ablation (sphere) number and the optimal overlapping mode and procedure for adequately ablating a large and spherical target lesion. The target ablation volume consisted of a tumor plus a 0.5- 1.0 cm tumor-free margin. The operation method for electrode placement was also described. Based on this mathematical protocol, 113 patients with 124 hepatic tumors [( 4.75? 0.92)cm in diameter, ranging from 3.6- 7.0 cm] were enrolled and treated. Seventy-one patients had 76 primary and 42 had 48 metastatic hepatic tumors. Results Totally 554 ablations (electrode placements) were performed in 124 tumors. The tumor complete necrosis rate was 87.9% (109/124), the local recurrence rate 24.2% (30/124), the estimated mean time to local recurrence 17.3 months. Twenty-five patients had received 38 retreatments for the local recurrence (17 received one time, and 8 received two or three times). Major complications were found in 7 patients (6.2 %). Of them, only one patient who suffered from colon perforation one week after RFA treatment required surgical intervention. Conclusions A theoretic basis and clinical guidance in RFA of hepatic tumors larger than 3.5 cm might be provided. Treatment results indicated that the protocol might probably be used to improve complete necrosis rate and reduce local recurrence rate in ablation therapy. The protocol was firmed effective and feasible.

BACKGROUND:Currently, inhaled glucocorticoid is still the classic treatment for asthma. Adult stem cell transplantation has made significant progress in a variety of diseases, and it also provides new insights into the treatment of asthma.OBJECTIVE:To summarize the recent advances in the treatment of asthma with adipose-derived stem cells and related adult stem cells, and to discuss the therapeutic safety of adipose-derived stem cells and possible research directions in asthma therapy.METHODS:Relevant articles published from 2001 to 2016 were searched in PubMed, CBM, CNKI, and Wanfang databases. The keywords were (adipose-derived stem cells[All Fields]) OR (adipose stem cells[All Fields]) OR (adipose-derived mesenchymal stem cells[All Fields]) AND (asthma[All Fields]) in English and Chinese, respectively.RESULTS AND CONCLUSION:A total of 125 literatures were initially searched, and finally 54 representative papers were selected. Adipose-derived stem cells may reduce airway inflammation, airway hyperresponsiveness, ease collagen deposition and scar tissue formation, promote neovascularization, and reconstruct damaged airways in the mouse asthma model through immune regulation. It is necessary to understand its treatment mechanism of action deeply and comprehensively and carry out genomic analysis before introduction of adipose-derived stem cells as a conventional clinical treatment. In summary, adipose-derived stem cells may be a therapeutic potential for the treatment of airway allergic inflammatory diseases such as asthma.

Objective To investigate the association of uric acid,bilirubin and hs-CRP with coronary lesion.Methods Four hundred and twenty nine patients who had underdone coronary angioplasty and completed clinical examination of TG,TC,LDL-C,HDL-C,BUN and SCr were divided into the normal vessel group,scleratheroma group(coronary stenosis

Objective To investigate the current situation of radiation protection capability and personal protection in the clinical practice of interventional radiology in grade-Ⅲ hospital.Methods A total of 108 medical staffs including physicians,technicians and nurses,who worked in interventional room,CT/ MR room,interventional catheterization room,radiotherapy department or radiology department in a grade-Ⅲ hospital of Guangdong province during the period from June 2014 to November 2015,were enrolled in this questionnaire investigation.The contents of self-mnade questionnaire included general demographic data,personal radiation exposure and protection.By using self-made questionnaire about the radiation protection capability of interventional work (both I-CVI and S-CVI being 0.9) the interventional radiation protection capability of the hospital was evaluated.Results In a certain grade-Ⅲ hospital of Guangdong province,the protection capability in shielding facilities,operating time and distance protection was quite strong,but the health-care leave system was lack,the occupational hazard detection was insufficient,and the protection and training system was poorly executed.In aspect of personal protection,the usage rate of lead apron in interventional procedures was only 72.2％,moreover,the rate of not wearing a radiation detector was up to 4.6％,and 9.3％ of medical staff didn't know the correct wearing position of a radiation detector.Conclusion The medical institution is lack of enough attention to the personal radiation protection as well as to the occupational health of interventional medical staff.In part of the medical staff,the consciousness of radiation protection is weak and the protection knowledge is insufficient,they are lack of adequate attention to occupational protection.All these issues need to be further improved.

Objective To analyze the findings of recurrent/residual caner after thyroidectomy for thyroid cancer in both ultrasonography (US) and contrast-enhanced CT (CECT),and to assess the diagnostic value of combination of these two modalities.Methods Forty-six patients with recurrence/ residue of thyroid cancer underwent both high-frequency US and CECT examinations and were enrolled in this study.The imaging features on US and CECT were reviewed and diagnostic accuracies for local residual lesions and cervical lymph node metastasis were evaluated according to pathological results.Results In 46 patients,the average period between thyroidectomy and diagnosis of recurrent/residual cancer was (14.6 ± 12.1) months(range,7 days-10 years).Twenty patients had local recurrent tumors at the surgical bed and the average size of tumors was 2.1 cm(range,0.5-4.6 cm).On US finding,the recurrent/residual tumors were hypoechoic in 60 ％ of cases,had microcalcification in 40 ％.Cervical lymph node metastasis were found in 40 patients,and 75％ of them were located in zone V[.The smallest size of abnormal lymph node which can be detected by US was 3 mm.In cases of lymph node metastasis,12 cases (30％) became cystic,10 (25 ％) presented microcalcifications,and 5 (12.5 ％) showed microcalcifications and cystic change within a lymph node.Microcalcifications,cystic change and hyperechoic appearance within a lymph node suggested malignant.The detection rate of US and CECT in the local recurrent/residual cancer were 90％ and 90％,respectively.The detection rate of cervical lymph nodes metastasis were 80 ％ and 72.5 ％,respectively.The diagnostic accuracy of US and CECT in local recurrence,cervical lymph node metastasis and both were 65％,67.5％ and 65.2％ vs 75％,55％ and 65.2％,respectively (P ＞ 0.05 for all comparisons).the diagnostic accuracy of combination of US and CECT were increased to 86.4％,77.5％ and 91.3％,respectively.US combined with CECT significantly improved the diagnostic capability compared with US or CECT alone(P ＜0.05).Conclusions US should be used as the first choice of imaging examination for post-thyroidectomy of thyroid cancer.US combined with CECT could further increase the diagnostic accuracy in recurrent/residual thyroid cancer.

Objective To evaluate the early diagnostic values of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) in patients with ventilator associated pneumonia (VAP).Methods A total of 112 clinical suspicion VAP ventilator-associated pneumonia (VAP) patients accepted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay separately made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Results A total of 112 clinical suspicion VAP patients admitted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Conlclusions In suspected VAP patients,measurement of sTREM-1 levels in BALF and in serum could help identify VAP in early stage.

ObjectiveTo evaluate prognostic factors affecting local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).MethodsA total of 246 HCC patients (343 lesions) underwent RFA treatment in our department and were enrolled into this study.The average tumor size was 3.7 cm ( range 0.9 ～ 3.7 cm).Regular follow-up with enhanced CT was performed to evalutate the treatment results.Kaplan-Meier model and log-rank test were used in univariate analysis and COX regression model was used in multivariate analysis to identify risk factors for local tumor progression.ResultsThe local tumor progression rate was 11.4％ (39/343 lesions),and the average time from initial RFA to local tumor progression was 12.0 months.Univariate analysis indicated tumor size ( P ＜0.001 ),close to intrahepatic vessels ( P ＜0.001),tumor boundary ( P =0.020),pathological grade( P =0.010) and CEUS before RFA ( P =0.001) as risk factors for local progression.The following factors were identified as independent prognostic factors for local tumor progression by multivariate model:tumor size (P ＜ 0.001),isolated or close to intrahepatic vessels( P ＜0.001) and CEUS before RFA(P =0.018).ConclusionsTumor size,CEUS before RFA and close to intrahepatic vessels are the most important factors for local progression after RFA.Being awaring of possible risk factors for local tumor progression may increase the treatment efficacy and help to promote the use of RFA technique.

Objective To detect CT appearances of different stomach diseases and evaluate the value of CT in the diagnosis of gastric diseases.Methods 62 cases of stomach diseases were detected by CT.Results 49 cases of gastric cancer,7 cases of stomach leiomyoma,3 cases of stomach ulcer,1 cases pylorus fleshy were examined,2 cases of stomach epineurial tumor.There was 91% correspondent rate of CT with pathologic examination.Conclusion CT imaging analysis is not only important to determine to gastric cancer,but also is great valuable to diagnose and differentiate the different stomach diseases.

The effect of reaction media cosolvent water activity, temperature and pH on Novozym 435-caulyzed enantioselective esterification of ketoprofen was systematically explored. Novozym 435 showed high catalytic activity and enantioselectivity in cyclohexane; E value increases markedly by addition of toluene to cyclohexane; the optimum temperature and the initial water activity were found to be 30℃ and 0.09 respectively; pH shows little effect on enzymatic reaction wilson the scope studied.