The clinical data of 192 patients undergoing endoscopic thyroidectomy via thoracic and mammary approach from June 2010 to July 2015 were retrospectively analyzed.Tunnel bleeding occurred in 11 cases (hemorrhage group),which was associated with the incorrect level of puncture(P ＜ 0.01).The tunnel bleeding was stopped by percutaneous packet-suturing in all 11 cases.There were no significant differences in postoperative drainage [(65.4 ± 7.5) and (63.8 ± 7.1) ml],subcutaneous petechiae [1/11 and 1.1％ (2/181)],nursing costs[(135 ±20) and(132 ± 16) yuan],postoperative hospital stay[(4.5 ± 1.6) and (4.4 ± 1.3) d] and rehemorrhage [0/11 and 0.6％ (1/181)] between hemorrhage and nonhemorrhage groups.The results show that percutaneous packet-suturing is reliable and effective method for tunnel bleeding without additional postoperative complications.

With the rapid development of biotechnology such as NGS and proteomics , bioinformatics has seen an explo-sion in diversity and complexity in terms of data , tools and demands .The traditional computing environment , including ded-icated workstations and virtual machines , are no longer suitable under such circumstances .As a rising container technolo-gy, Docker, which is characterized by light weight , openness and security ,has provided an innovative solution to analysis and processing of biological big data and attracted increasing attention from bioinformatics developers and users .Consider-ing the demands and features of development , deployment and application of bioinformatics tools in the age of big data , this paper analyzes the advantages of Docker in this field , introduces some actual cases and discusses current deficiencies and future improvement .

Objective To investigate the application efficacy of disposable circumcision stapler with compound lidocaine cream combined with lidocaine injection in the circumcision.Methods From September 2013 to November 2014,120 cases (11 cases of redundant prepuce phimosis patients), were divided into disposable circumcision suture group (S group, 60 cases) and conventional circumcision (T group, 60 eases) ,two groups had no statistically significant difference at patient age and wrapping case (6 cases phimosis of S group,5 cases phimosis of T group) (P ＞0.05.Patient's age ranged from 11 to 49 years.30 patients in each group were treated with lidocaine cream combined with lidocaine injection,and another 30 patients were treated with a local anesthetic lidocaine injection.Comparisons were conducted among the four groups on the operation time, anesthesia, intraoperative and postoperative pain score, blood loss and postoperative complications, postoperative appearance satisfaction, wound healing time.Results For the disposable circumcision stapler with lidocaine cream combined with lidocaine injection group, disposable circumcision stapler with lidocaine injection group, sleeve circumcision with lidocaine cream combined with lidocaine injection group and sleeve circumcision with lidocaine injection group, the operation time was (5.3 ± 1.5) min, (4.9 ± 1.4) min, (31.6 ± 3.4) min, (32.0 ± 3.3) min respectively, blood loss was (0.6 ± 0.4) ml, (0.8 ± 0.5) ml, (6.9 ± 2.4) ml, (7.5 ± 2.1) ml respectively, narcotic pain score was 0.6 ± 0.6,3.2 ±3.9,2.5 ± 1.0,0.5 ±0.6,intraoperative pain score was 0.8 ±0.9,1.4 ±0.8,2.2 ± 1.1,3.1 ± 1.1,postoperative 24 h pain score was 1.6 ±0.9,2.2 ±0.8,2.6 ± 1.3,4.4 ± 1.1, postoperative 48h pain score was 0.7 ±0.6,0.8 ±0.9,2.4 ±0.8,2.8 ±0.7, wound healing time was (13.7 ±1.5)d,(13.5 ± 1.7)d, (14.2 ± 1.3) d, (14.1 ± 1.6) d, the rate of postoperative complications was 6.6％ (2/30), 10.0％ (3/30),26.6％ (8/30), 33.4％ (10/30), satisfaction rate of appearance was 93.4％ (28/30), 96.7％ (29/30),70.4％ (22/30), 80.0％ (24/30).Compared with sleeve circumcision with lidocain injection group,disposable circumcision stapler with lidocaine cream combined with lidocaine injection had a shorter operation time, less pain, less bleeding, higher appearance satisfaction rate and lower incidence of complications (P ＜ 0.05), wound healing time had no significant difference (P ＞ 0.05).Conclusion Application of the disposable circumcision stapler with lidocaine cream combined with lidocaine injection on circumcision is safe and has got better clinical outcomes.

Objective To evaluate the reliability and validity of the Chinese Version of Communication and Sharing of Information Scale(CSI) in the the assessment of the efficacy and quality of collaboration of the physician and nursing related staffs.Methods All the sample enrolled from 10 hospitals of Tianjin,all the subjects voluntarily signed the informed consent.Totally 600 subjects were tested by CSI.Exploration and confirmation factor analysis were used to examine the construct validity.Cronbaeh' s α was applied for examining internal consistency of the scales,the correlation analysis was used to examining the test-retest reliability of the scales.Results Exploratory Factor Analysis revealed that Communication and Sharing of Information Scale included 3 factors:Communication with nursing related staff,Communication with physician,Medical information sharing.Confirmation Factor analysis revealed that x2/dfwas 5.760,NNFI 0.900,GFI 0.945,AGFI 0.923,REMEA was 0.06,all reached the correction criteria of the scale,indicated that this scale had good construction validity.Cronbach' sαof the total scale was 0.870,the Cronbach' s α of the 3 factors were 0.780,0.788,0.815 respectively,indicated this scale had good inner-consistency.The total scale test-retest reliability was 0.870 after 1 week in 100 subjects randomly enrolled from all the previous subjects,indicated this scale had good reliability.Conclusion CSI has good reliability and validity and is suitable to assess the efficacy and quality of the collaboration of the physician and nursing related staffs.

Objective To study the safety and efficacy of fast track program in anorectal surgery perioperative period. Methods One hundred and sixty-nine cases of rectal cancer were divided into the study group of 86 patients with fast track program, and the control group of 83 patients with traditional programs by random digits table. Both groups were compared from the time out of bed, the first intestinal discharge time,intravenous fluids stopping time,length of hospital stay,total cost of treatment and the incidence of postoperative complications. Results The study group compared with the control group: the first intestinal discharge time [(33.6 ± 12.9) h vs. (81.7 ± 20.1) h], intravenous fluids stopping time [(4.5 ±1.3) d vs.(7.4 ± 1.6) d],and length of hospital stay [(5.6 ± 1.2) d vs.(8.9 ±2.7) d],the total cost of treatment [(15 000 ± 3000) yuan vs. (16 000 ± 4000) yuan], the differences were statistically significant (P ＜ 0.01 or ＜ 0.05),and had less incidence of postoperative complications in study group than that in control group [5.8% (5/86) vs. 16.9% (14/83)], the difference was statistically significant (P ＜ 0.05).Conclusions Fast track program in anorectal surgery perioperative period is safe and effective, beneficial,conducive to rehabilitation of patients.

ObjectiveTo investigate the role of chemoradiotherapy in the preoperative radiotherapy for locally advanced head and neck squamous cell carcinoma. MethodsFrom Sep. 2002 to Dec. 2008,totally 157 locally advanced head and neck squamous cell carcinoma (HNSCC) patients was assigned to preoperative concurrent chemoradiotherapy group ( n =81 ) or preoperative radiotherapy alone group ( n =76 ) randomly. The chemotherapy regimen was consisted of cisplatin 30 mg/m2, weekly. The radiotherapy in both groups was identical. The primary lesion will continue concurrent chemoradiotherapy or radiotherapy for those the tumor response was or nearly complete remission (CR) and those who refused surgery when evaluated at DT50 Gy, the others will receive surgery 1 month later if the tumor response was less than CR.For N3 patients, the planed neck dissection will be done. ResultsThe follow up rate was 98. 1％, 91patients followed up more than 5 years, there were 46 in concurrent chemoradiotherapy group and 45 in radiotherapy alone group. The rate of 5-year local control, overall survival, disease free survival and distant metastasis-free survival for preoperative concurrent chemoradiotherapy group and preoperative radiotherapy alone group were 63％ and 50％ ( x2 =0. 40,P =0. 528), 46％ and 38％ ( x2 =0. 48,P =0. 490) ,41％ and 35 ( x2 =0. 29, P =0. 593 ) ,76％ and 65％ ( x2 =3.38, P =0. 066 ) respectively. Subgroup analysis showed that the 2-years distant metastasis-free survival of preoperative concurrent chemoradiotherapy group and preoperative radiotherapy alone group were 88％ and 60％ ( x2 =5.99,P =0. 014). ConclusionsPreoper -ative concurrent chemoraidotherapy with the regimen of cisplatin 30 mg/m2 weekly did not improve the overall survival for locally advanced HNSCCwhen compared with preoperative radiotherapy alone.Preoperative concurrent chemoradiotherapy improved the distant metastasis-free survival of locally advanced hypopharyngeal and laryngeal carcinoma.

Objective: To investigate the clinical value of multimodal navigation-based virtual reality (MNVR) in the needle biopsy of intracranial eloquent lesions. Methods: From January 2016 to January 2017, 20 patients with intracranial deep-seated lesions involving eloquent brain areas underwent MNVR-aided needle biopsy at Department of Neurosurgery, People′s Liberation Army General Hospital. Preoperatively, MNVR was used to propose and revise the biopsy planning. Intraoperatively, navigation helped trajectory avoid the eloquent structures. Intraoperative MRI (iMRI) was performed to prove the biopsy accuracy and detect the intraoperative complications. Perioperative neurological status, iMRI findings, intraoprative complications, surgical outcome and pathological diagnosis were recorded. Wilcoxon rank-sum test was conducted to compare the preoperative and postoperative neurological scores. Results: MNVR helped revised 45%(9/20) initial biopsy trajectories, which would probably injury the nearby eloquent structures. Navigation helped biopsy trajectories spare the eloquent structures during the operation. No statistical difference was found between postoperative and preoperative neurological status, despite all the lesions were adjacent to eloquent areas. Additionally, 20 patients totally received 21 iMRI scanning. iMRI helped revise incorrect biopsy site in one case and detected intraoperative hemorrhage in another case, both of cases were treated immediately and effectively. No MNVR related adverse events and complications occurred. Conclusions MNVR-aided needle biopsy of intracranial eloquent lesions is a safe, novel and efficient biopsy modality. This technique is helpful to reduce the incidence of surgery related neurological deficits.

Objective:To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups.Methods:All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96 Gy (27.56-76.00 Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250 mg (100-570 mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan- Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results:The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup ( P=0.009), and there was an increasing trend in patients aged≤55 years and female patients ( P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T 4( P=0.048), N 3( P=0.005), non-IMRT treatment ( P=0.001) and hypopharyngeal carcinoma ( P=0.004) subgroups, there was an increasing trend in male ( P=0.064), high-and moderate-grade squamous cell carcinoma ( P=0.076) and non-surgical treatment subgroups ( P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years ( P=0.017 and 0.039), women ( P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma ( P=0.006 and 0.022), N 3 stage ( P=0.001 and 0.017), non-surgical treatment ( P=0.007 and 0.033) and non-IMRT treatment subgroups ( P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma ( P=0.022). Conclusion:Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N 3 stage, non-surgical treatment and non-IMRT treatment patients.

Objective:To summarize the clinical, imaging, and pathological characteristics of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS) to improve the diagnosis of this rare disease.Methods:A retrospective case series was conducted to collect the clinical data and results of genetic testing, muscle biopsy, and imaging studies including computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS) of 35 patients with MELAS admitted to the Nanjing Drum Tower Hospital from 2012 to 2021. Descriptive statistical analysis including mean, standard deviation, and frequency percentage were carried out.Results:The average age of onset of the patients was 30.2±2.3 years; the prevalence of family history was 20%. The two main initial symptoms were limb weakness and convulsions. The clinical manifestations of the neuromuscular system were proximal muscle weakness and exercise intolerance. The endocrine system is the most affected outside the neuromuscular system, with diabetes being the most common condition. Among the five patients who underwent brain CT, four showed hypodense lesions and two had calcified lesions. Brain MRI in 26 patients showed that the lesions more often affected the parietal lobe, basal ganglia, temporal lobe, occipital lobe, and frontal lobe than the infratentorial areas. Twelve of these individuals exhibited different levels of brain atrophy. Among the 10 patients who underwent 1H-MRS, nine showed a decrease in N-acetylaspartate (NAA) levels, eight exhibited abnormal lactate elevation (Lac peaks), whereas six had both reduced NAA levels and the presence of Lac peaks. Thirty-one patients underwent genetic testing; among them, 25 were found to have the mt.3243A>G mutation, while the remaining six exhibited rare gene alterations. Muscle biopsies were performed in 21 patients, and 15 showed abnormal mitochondrial proliferation manifested by ragged red fibers and defective oxidative phosphorylation manifested by cytochrome C oxidase (COX) enzyme-deficient muscle fibers. Conclusion:The clinical manifestations of MELAS syndrome are variable and complex, and early atypical symptoms could be missed or misdiagnosed. A detailed clinical history, imaging MRS analysis, muscle biopsy, and genetic testing are necessary to confirm the accurate diagnosis of MELAS.

Objective:To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m 2 every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50 Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan- Meier method. Results:The median follow-up time was 59 months (7-139 months). All patients were divided into four groups: radiotherapy group (R group, n=84), concurrent chemo-radiotherapy group (R+ C group, n=67), preoperative radiotherapy group (R+ S group, n=34) and preoperative concurrent chemoradiotherapy group (R+ C+ S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+ C+ S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+ C Group vs. R group, P=0.081; R+ C+ S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+ C group vs. R+ S group, P=0.064; R+ C group vs. R+ S group, P=0.016). Conclusions:Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.