Chinese traditional surgery, an important branch of traditional Chinese medicine, has contributed greatly to the people's health in the history. With the fast development of modern medicine, Chinese traditional surgery is faced with serious challenges and its shortcomings have appeared more and more evident. In this article, the authors analyzed some problems in the development of Chinese traditional surgery and the opportunities for its further development, and suggested that the superiorities of Chinese traditional surgery should be enhanced in its future development.

Objective:To explore the reliability of Xpert MTB/RIF (Xpert) in the diagnosis of pulmonary tuberculosis and to understand the characteristics of retreated patients, so as to provide clues for the investigation of retreated patients.Methods:905 patients sputum with suspected tuberculosis from July 2019 to December 2019 were collected from the Tuberculosis Department of Changsha Central Hospital. Xpert was used for rapid screening of tuberculosis. MGIT960 and Roche culture method were used for rapid sputum culture and drug sensitivity, respectively. Rifampin (RIF) resistance was compared between Xpert and Roche culture. The gender, age, RIF resistance, occupation and diabetes mellitus of patients with positive Xpert were compared, and the risk factors of RIF resistance were analyzed by binary logistic regression.Results:The total detection rate of Xpert was 28.7%(260/905) in 905 suspected pulmonary tuberculosis patients; RIF resistance rate accounted for 20.8%(54/260) in 260 positive patients, and the main mutation types were probe-E and probe-D. There was no significant difference between traditional drug sensitivity and Xpert method in RIF resistance detection ( P>0.05); There was no significant difference between Xpert method and traditional drug sensitive cases in predicting isoniazid (INH) resistance ( P=0.293); there were significant differences in age ( t=-3.835, P<0.05), gender, RIF resistance rate and proportion of farmers between newly treated and retreated patients (χ 2=5.091, 16.862, 4.808, P<0.05); Binary logistic regression showed that retreatment was a risk factor for RIF resistance ( OR=3.739, P=0.004). Conclusions:Xpert has high clinical value in the diagnosis of pulmonary tuberculosis and RIF resistance; The retreated patients were older, and the proportion of male farmers was larger, with higher resistance rate to RIF.

Nipple discharge is one of main symptoms about breast disease.Furthermore,the haematodes nipple discharge is earlier clinical manifestation of breast duct cancer.How to make diagnosis about the dis-ease of nipple discharge better,especially the early diagnosis of breast duct cancer,is the responsibility of breast specialists.There are several usual examinations about breast,but they are below the mark about some breast disease which have no lump or have minimal changes.Whole breast ultrasonic scanning and breast ultrasound computer-assisted diagnose system make the diagnosis of the disease of nipple discharge better than before in recent years.3D-reestablishment of this diagnose system can make doctor conveniently observe the disease in spatial position and know the relationgshep between disease and peripheric tissue.In this way,doctor can definit the property of disease more exactly and make early diagnosis of breast tumor more easier.

The paper described the necessity of social capital utilization for public hospitals, and analyzed the model and characteristics of public hospital financing. It is pointed out that the key to the public-benefit nature in the financing calls for distinguishing responsibilities of the government and the market, defining the reasonable level and manner for investors' return, and building corresponding incentive mechanism and supervision mechanism.

Objective:To investigate the therapeutic effects of antibiotic articular cement spacer on shoulder joint infection in the elderly patients during stage-one operation.Methods:The data of 3 patients were analyzed retrospectively who had been treated at Department of Orthopaedics, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University for shoulder infection from May 2018 to December 2019. They were one man and 2 women with an average age of 65.3 years (from 64 to 67 years). One case of infection followed shoulder puncture, another proximal humeral fracture and another shoulder prosthesis replacement. All the 3 patients underwent radical debridement and implantation of antibiotic shoulder cement spacer in stage-one operation but no stage-two operation. The therapeutic effects were evaluated by American Shoulder and Elbow Surgeons (ASES) scoring, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scoring, Visual Analog Scale (VAS), and range of shoulder motion.Results:The 3 patients were followed up for 18 to 28 months (mean, 22.7 months). There was no recurrence of infection and the spacers were in good position. The microorganisms detected were Bifidobacterium brevis in one case and methicillin-resistant Staphylococcus aureus in 2 cases. At the final follow-up, the ASES scores averaged 54.4 (from 46.3 to 60.0), Quick-DASH scores 45.1 (from 40.8 to 50.0), VAS scores 2.3 (from 2 to 3), ranges of elevation 65.7 °, ranges of abduction 43.8° and ranges of external rotation 21.7°.Conclusion:For the elderly patients with shoulder infection, implantation of antibiotic shoulder cement spacer after radical debridement can well control infection, relieve pain and improve shoulder functions, sparing them secondary operation.

BACKGROUND: Some studies have showed that after indirect co-culture, bone marrow mesenchymal stem cells can differentiate into myocardial cells and hepatocypte-like cells. OBJECTIVE: To investigate the possibility of human umbilical cord blood mesenchymal stem cells (UCB-MSCs) to differentiate into hepatocytes by co-culture with human hepatocyte line LO2 in vitro.METHODS: Full-term umbilical cord blood samples were obtained sterilely. The UCB-MSCs were isolated by density gradient centrifugation and directly adherence growth, then passaged with trypsin digestion at 80% cell fusion. By utilizing cell culture plate insets with microporous membrane combined with 6-well plate, the LO2-/UCB-MSCs co-culture system was established. UCB-MSCs were plated into the wells of 6-well plate at a density of 1×10~7/L. LO2 cells were plated into the cell culture plate insert at a density of 1×10~5/L. UCB-MSCs were plated in both layers in the control group. Surface markers of adhered cells were detected by flow cytometry. Morphological changes of UCB-MSCs were observed by inverted phase contrast microscopy. mRNA expression was detected by reverse transcriptase PCR. RESULTS AND CONCLUSION: HUCB MSCs expressed CD44 and CD29 strongly, but CD34 and CD45 were expressed negatively. After 5 days, fusiform-shaped cells were reduced in the co-culture group; while, the time passing by, cells shaped irregular round or polygonal were increased, which were similar to hepatocytes. At 4 weeks after culture, UCB-MSCs were still fusiform-shaped in the control group. At day 5 after culture, alpha fetoprotein mRNA expressed positively, but other expressed negatively in the co-culture group; at day 14 after culture, cytokeratin-19 mRNA and albumin mRNA expressions were observed; moreover, with the time passing by, the expression of albumin mRNA was increased, but the expression of alpha fetoprotein-19 mRNA was decreased. Antigenic expressions in the control group were negative. This suggested that UCB-MSCs could differentiate into hepatocypte-like cells by co-culture with human hepatocyte line LO2 in vitro.

Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; prevention & control ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Middle Aged ; Phytotherapy ; Radiography

Objective The aim of this study is to evaluate the safety and efficacy of partial pancreatectomy as part of primary cytoreductive surgery in advanced epithelial ovarian cancer (EOC). Methods A total of 8 patients were recruited in this study who underwent partial pancreatectomy during the primary cytoreductive surgeries for advanced EOC in Fudan University Shanghai Cancer Center from April 2009 to July 2015. Their clinicopathological characteristics, diameter of metastatic tumors, the scope of cytoreductive surgeries, residual diseases after cytoreductive surgeries, postoperative complications and survival situation were retrospective analyzed. Results (1) Clinicopathological characteristics:the median age of these patients was 58 years old(range: 39-63 years old). The median value of preoperative serum CA125 was 1 688 kU/L(range: 119-5 000 kU/L). The median diameter of metastatic tumors involved in pancreatic body or tail was 4.5 cm (range:3-10 cm). All the tumors from the 8 patients were confirmed to be high-grade serous carcinoma. Four patients were staged as International Federation of Gynecology and Obstetrics (FIGO)Ⅳ, and the other 4 patients were staged as FIGOⅢc. (2) Tumor metastases and the scope of cytoreductive surgeries:all of these 8 patients had widely disseminated ovarian cancer, with involvement of upper abdominal, middle abdominal and pelvic cavity. Each patient underwent extensive intra-abdominal cytoreductive surgeries, including hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic periton-ectomy, splenectomy, partial pancreatectomy. Each patient had cytoreductive surgeries of 9.6 different sites on average. Of all 8 patients who underwent partial pancreatectomy, 7 patients had pancreatic tails removed;the other 1 patient had pancreatic body and tail removed. The median volume of blood loss during surgery was 1 350 ml(range:300-3 500 ml), blood transfusion was performed in 7 patients with the median volume of 1 150 ml (range: 500-1 800 ml). (3) Residual diseases after cytoreductive surgeries: optimal cytoreduction was achieved in all patients, with microscopic residual disease in 3 patients, residual tumors diameter < 0.5 cm in 3 patients, and residual tumors diameter between 0.5 and 1 cm in 2 patients. (4) Postoperative complications: 4 patients suffered from complications including pancreatic leakage (2/8), intraperitoneal hemorrhage (1/8) and pancreatic pseudocyst accompanied by infection (1/8). These complications were treated successfully by conservative managements. (5) Survival situation: during the median follow-up duration of 17 months (ranged from 2 to 46 months), 5 patients were still alive until the end of follow-up, including 4 cases under treatment and 1 case survived 29 months without relapse after treatment. Three patients were respectively died in 5, 20 and 46 months after surgery. Conclusion There is a higher risk of postoperative complications of pancreas resection as part of primary cytoreductive surgery in advanced epithelial ovarian cancer, but the resection of pancreatic metastases and part of the pancreas is feasible and necessary.

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Objective To analyze the clinical effects, complications and prognosis of primary chemotherapy combined with postoperative intraperitoneal hyperthermic perfusion chemotherapy in the treatment of advanced ovarian cancer. Methods The clinical data of 64 patients with advanced ovarian cancer in Shanxi Provincial Cancer Hospital from May 2015 to May 2017 were analyzed retrospectively. Conventional cytoreductive surgery (CDS) was performed in all patients. According to the different therapeutic regimen before and after operation, the patients were divided into 2 groups, including 32 cases treated with primary chemotherapy combined with postoperative intraperitoneal hyperthermic perfusion chemotherapy (the observation group), and 32 cases treated with intraperitoneal hyperthermic perfusion chemotherapy after operation (the control group). The clinical effect, complications and prognosis were compared between the two groups. Results The blood loss in the observation group [(512±165) ml] was lower than that in the control group [(815±186) ml]. The amount of ascites in the observation group [(716±160) ml ] was lower than that in the control group [(1 279±236) ml], and the differences were statistically significant (t= 6.890, t= 11.153 respectively, both P＜ 0.05). Moreover, the duration of surgery in the observation group was shorter than that in the control group [(125 ±15) min vs. (185 ±24) min; t = 18.572, P＜ 0.05]. The total incidence of complications and 2-year recurrence rate in the observation group were lower than those in the control group, and the 2-year survival rate in the observation group was higher than that in the control group (both P＜0.05). Conclusion Primary chemotherapy combined with postoperative intraperitoneal hyperthermic perfusion chemotherapy for advanced ovarian cancer has a favorable effect with less complications and good prognosis, which is worthy of clinical application.